The advantage of tight control and treat to target in new-onset ra patients in daily rheumatology practice: results from a contemporary university clinic inception cohort

Background Since 2018, all patients with new-onset rheumatoid arthritis (RA) at the Department of Rheumatology, Skane University Hospital, Lund, Sweden, are offered to participate in a ”tight control” and ”treat to target” (TC+T2T) follow-up strategy. This strategy includes regular follow-up visits to a rheumatologist (at diagnosis and 3, 6, 12, 18, 24 months) plus physical/telephone consultations with a rheumatology nurse between physician visits, both with disease activity assessments and, if needed, adjustment/intensification of anti-rheumatic treatment aiming for remission. Objectives To explore the possible advantages of integrating this TC+T2T strategy over routine care, aiming more systematically for remission (DAS28<2,6 or CDAI≤2,8), in clinical practice of new-onset RA. Methods Patients followed by the TC+T2T strategy were compared to new-onset RA patients followed according to routine care at the same department and during the same period. Data on disease and treatment characteristics, as well as outcome measures during follow-up were retrieved from the Swedish Rheumatology Quality register (SRQ). In total, 156 patients with at least 3 months follow-up between 2018 and 2021 were included; 95 followed according to the TC+T2T strategy and 61 according to routine care. Percentage females/mean age at onset/mean symptom duration at diagnosis were 79%/57 years/4 months (TC+T2T) and 62%/62 years/7 months (routine care). The change in DAS28 and CDAI from baseline to 12 months follow-up were compared between the two strategies by linear regression analyses, adjusted for sex, age, symptom duration, and DAS28 or CDAI, respectively, at baseline. In addition, changes in patient-reported outcomes (fatigue, pain and HAQ) are calculated. Results Disease and treatment characteristics at inclusion (diagnosis) are summarized in the Table 1. Table 1. TC+T2T group (n=95) Controls (n=61) Swollen 28 joint count, 6,6 (4) 5,1 (5) Tender 28 join count 8,2 (5) 6,2 (6) ESR 48,1 (29) 37,7 (25) CRP 21,3 (29) 16,9 (23) DAS28 5,5 (1) 4,6 (1) CDAI 24,5 (11) 18,3 (11) HAQ 1,01 (0,6) 0,98 (0,7) Fatigue (VAS) 50,1 (29) 46,6 (30) Pain (VAS) 57,9 (24) 47,3(30) ACPA positive (%) 77% 53% Radiographic changes in hands or feet at inclusion (%) 12% 18% Smoker (%) 16% 7% Methotrexate started at inclusion (%) 78% 85 % Prednisolone started at inclusion (%) 100% 97% Mean and standard deviation (SD) if not otherwise stated. The TC+T2T strategy resulted in greater improvements in DAS28 and CDAI scores from inclusion to 12 months follow up (p=0,025 and p=0,026; respectively; Figure 1). Beyond improvements in DAS28 and CDAI, a significant decrease in patient-reported outcomes (fatigue and pain) during 12 months from diagnosis was observed (Figure 1). Conclusion Compared to routine rheumatology practice, the implementation of a ”tight control” and ”treat to target” strategy resulted in a greater improvement in disease activity and an early and sustained improvement in patient-reported outcomes. Our results suggest that this type of strategy should be integrated into daily clinical practice of new-onset RA. Disclosure of Interests Jon Thorkell Einarsson: None declared, Katarina Friberger Pajalic: None declared, Caroline Bengtsson: None declared, Elisabeth Mogard: None declared, Elisabet Lindqvist: None declared, Carmen Roseman: None declared, Olafur Palsson: None declared, Johan K Wallman Consultant of: Consultant of AbbVie, Amgen, Celgene, Eli Lilly, Novartis, Grant/research support from: Research support from AbbVie, Amgen, Eli Lilly, Novartis, Pfizer. Tor Olofsson Consultant of: consultant of MSD, Meliha C Kapetanovic Consultant of: Abbvie, Pfizer, GSK, Grant/research support from: unrestricted grants from Pfizer and Roche.