Are We Bang On Target? An investigation on the Efficacy & Efficiency of the Treat To Target Clinic Model, Rheumatology Department, Tallaght Hospital.
Department of Rheumatology, Adelaide and Meath Hospital, Tallaght Dublin 24
Suboptimal treatment of Inflammatory Arthritis (IA), which includes Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) and Ankylosing Spondylitis (AS), is associated with increased joint destruction, increased functional disability, and higher rates of mortality. The European League Against Rheumatism (EULAR) best practice guidelines for RA advocate aggressive early treatment using a sequential or step up approach using synthetic Disease Modifying Anti Rheumatic Drugs (sDMARD) or biological DMARD (bDMARD) therapies until low disease activity or remission levels of arthritis have been attained, as measured by a composite disease activity scoring method. In 2015, a Treat To Target (TTT) Clinic was initiated in the Department of Rheumatology, to maximise remission induction for patients with poorly controlled RA, PsA and AS
To compare the Rheumatology Treat To Target (TTT) Approach at Tallaght Hospital to International Best Practice guidelines for the management of Inflammatory Arthritis
Frequency of Composite Disease Activity Scoring Methods and Treatment Interventions at the TTT clinic appointments in Tallaght Hospital were compared to the European League Against Rheumatism (EULAR) recommendations for treatment escalation and disease monitoring for patients with Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) and Ankylosing Spondylitis (AS)
Only 34% of RA patients had a DAS28 composite disease activity score taken at clinic to guide treatment decisions. 9% of PsA patients had a composite disease activity score and 0% of AS patients had a composite disease activity score. Appropriate management decisions were taken according to global physician disease assessment, however a discrepancy between physician assessment and DAS28 scores indicates non-adherence to EULAR treatment recommendations for these patients
An education campaign among physician attendees leading to composite disease activity measures being performed to guide standard practice is required to attain best international standards. An education campaign, to implement changes followed by re-audit is recommended.