On the application of the “treat-to-target” strategy and the identification of a cohort of difficult-to-treat patients with rheumatoid arthritis in real-world clinical practice

Rheumatoid arthritis (RA) is an incurable but potentially controllable disease. The main goal of treatment is to achieve remission or low disease activity. Among difficult-to-treat patients, three groups are distinguished: patients whose treatment does not comply with the principle of “treat to target” (T2T) due to insufficient activity of the doctor, or due to non-compliance with the treatment regimen by the patient; cases where the central mechanisms of pain are not recognized; patients with “truly refractory RA.”

Objective: to evaluate the implementation of the T2T strategy in the real-world clinical practice of rheumatologists, and the physicians' understanding of the mechanisms of the development of a difficult-to-treat RA.

Material and methods. The study included three stages: 1) assessment of the duration of counting of DAS-28 index by doctors; 2) anonymous online survey of 43 rheumatologists from Yekaterinburg and the Sverdlovsk region; 3) assessment of patients' comprehension of the indicator “General activity of the disease”. The results of the study are presented in the form of descriptive statistics.

Results and discussion. The average counting time of the DAS28 is 1 min 16 s, but only 42% of rheumatologists calculated it correctly. The problem of physicians' insufficient attention to the subjective component of the DAS28 index and possible central sensitization as a cause of pain was revealed. Assessment of health is difficult and ambiguous for the patients.

Conclusion. The implementation of the T2T strategy in the treatment of patients with RA cannot be considered optimal today. Often the DAS28 index is used in a purely mechanical way without considering central sensitization, which can lead to overdiagnosis of the high inflammatory activity of RA as well as to unjustified changes in therapy.

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