Treat-to-target, evidence-based guidelines recommend that rheumatoid arthritis patients be monitored regularly for disease activity and that therapy is adjusted — whether increasing dosages or switching medications — at least every three months until a target of low disease activity, or remission, is reached.
But new research published in Arthritis Care & Research shows that 60 percent of patients with moderate- to high-disease activity adjusted their disease-modifying antirheumatic drug (DMARD) therapy within 90 days of getting better.
“However, 40 percent did not, suggesting there could be room for improvement with respect to the timeliness of therapy adjustments,” says Yomei Shaw, of the University of Pittsburgh and lead author of the study.
Patients who did adjust therapy within 90 days reached low disease activity or remission sooner than patients did who didn’t adjust therapy within 90 days, Shaw adds.
[Read about gaps between patient perceptions and disease improvement.]
Among the 538 patients that Shaw and colleagues identified from the University of Pittsburgh Rheumatoid Arthritis Comparative Effectiveness Research (RACER) registry, the researchers found “significant” association between slower therapy adjustment and patients who were elderly, had longer rheumatoid arthritis duration, took biologics, and had lower disease activity.
Longer times to reach low disease activity or remission were associated with patients who were African American, had higher disease activity, and didn’t adjust their DMARDs within 90 days.
The findings have implications today for rheumatoid arthritis patients, according to Shaw.
“If you have been on your current treatment regimen for a few months, you still have signs of moderate- to severely-active disease, and you are not improving, it may be a good idea to go see your rheumatologist to assess your disease activity and determine whether you should consider adjusting therapy,” she says.
“If your rheumatologist confirms that you have moderate- to high-disease activity and adjusting therapy is an option for you — not contraindicated — doing so within 90 days may help you reach low disease activity or remission sooner,” she adds.
[Check out our patient’s guide (PDF) to living with RA.]
“The study is useful in that it adds further evidence to the literature that very close monitoring of RA patients with careful and timely adjustments to medications is helpful in controlling morbidity and pain and preventing long-term dysfunction of the joints,” said Amish Dave, a rheumatologist at Virginia Mason Hospital in Seattle, in an interview with MedPage.
“Ultimately, we want to be very aggressive in treating patients,” he said. That’s true in particular, he added, for African American patients, who can often face a variety of challenges that make it harder for them to regularly adjust their therapy.