Clinical Characteristics of Rheumatoid Arthritis Patients in Malang: Where Are We Now According to the Treat-to-Target Strategy?
DOI:
https://doi.org/10.21776/ub.crjim.2023.004.02.04Keywords:
Rheumatoid Arthritis, disease remission, clinical characteristics, treat to targetAbstract
Background: Rheumatoid arthritis (RA) is the most frequent type of systemic inflammatory arthritis.
Aim: to observe RA patients' clinical characteristics in Malang and assess the adherence of the clinical data to the existing guideline for the treat-to-target (T2T) strategy.
Methods: This survey included 111 RA patients who visited the Rheumatology Clinic at Saiful Anwar Hospital in Malang. Patient's demographic information, medical and drug history, body mass index (BMI), tender joint count (TJC), swollen joint count (SJC), visual analogue scale (VAS) for pain, erythrocyte sedimentation rate (ESR), anti-cyclic citrullinated protein (CCP), and rheumatoid factor (RF) were all collected. The disease activity score for 28 joints - ESR (DAS28-ESR) was used to assess disease activity and remission.
Results: The mean duration of the disease was 2.9±1.6 years. Among those patients, four patients (3.6%) got disease remission, and two patients (1.8%) had low activity. Methotrexate (MTX) was given to all subjects for an average of 78.4±11.7 months at a dose of 9.5±2.8 mg/week. Six patients (5.4%) received the DMARD combination of MTX+LEF (4.5%) and MTX+SSZ (0.9%). Most subjects had delayed MTX initiation (mean duration 6.0±2.2 months after the first onset); 77 patients (69.3%) initiated their MTX after >6 months since the first onset. Most subjects got 7.5 mg/weeks (45.0%), while only 11.7% of patients had ≥15 mg/weeks of MTX.
Conclusion: The remission rate of RA patients in Malang is still low, which can be caused by inadequate adherence to the relevant guidelines and T2T strategy in clinical practices.
References
Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet. 2010 Sep 25;376 (9746):1094-108.
Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016 Oct 22;388 (10055):2023-2038.
van der Woude D, van der Helm-van Mil AHM. Update on the epidemiology, risk factors, and disease outcomes of rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2018 Apr;32(2):174-187.
Darmawan J, Muirden KD, Valkenburg HA, Wigley RD. The epidemiology of rheumatoid arthritis in Indonesia. Br J Rheumatol. 1993 Jul;32(7):537-40.
England BR, Tiong BK, Bergman MJ, Curtis JR, Kazi S, Mikuls TR, O'Dell JR, et al. 2019 Update of the American College of Rheumatology Recommended Rheumatoid Arthritis Disease Activity Measures. Arthritis Care Res (Hoboken). 2019 Dec;71(12):1540-1555.
Smolen JS, Landewé RBM, Bijlsma JWJ, Burmester GR, Dougados M, Kerschbaumer A, McInnes IB, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis. 2020 Jun;79(6):685-699.
Smolen JS, Breedveld FC, Burmester GR, Bykerk V, Dougados M, Emery P, et al. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis. 2016 Jan;75(1):3-15.
van Riel PL, Renskers L. The Disease Activity Score (DAS) and the Disease Activity Score using 28 joint counts (DAS28) in the management of rheumatoid arthritis. Clin Exp Rheumatol. 2016 Sep-Oct;34(5 Suppl 101):S40-S44.
Yu C, Jin S, Wang Y, Jiang N, Wu C, Wang Q, Tian X, Li M, Zeng X. Remission rate and predictors of remission in patients with rheumatoid arthritis under treat-to-target strategy in real-world studies: a systematic review and meta-analysis. Clin Rheumatol. 2019 Mar;38(3):727-738.
Chandrashekara S, Shobha V, Dharmanand BG, Jois R, Kumar S, Mahendranath KM, Haridas V, et al. Factors influencing remission in rheumatoid arthritis patients: results from Karnataka rheumatoid arthritis comorbidity (KRAC) study. Int J Rheum Dis. 2018 Nov;21(11):1977-1985.
Tan BE, Lim AL, Kan SL, Lim CH, Ng YF, Tng SLC, et al. Management of rheumatoid arthritis in clinical practice using treat-to-target strategy: Where do we stand in the multi-ethnic Malaysia population? Rheumatol Int. 2017 Jun;37(6):905-913.
Song JJ, Song YW, Bae SC, Cha HS, Choe JY, Choi SJ, Kim HA, et al. Treat-to-Target Strategy for Asian Patients with Early Rheumatoid Arthritis: Result of a Multicenter Trial in Korea. J Korean Med Sci. 2018 Dec 18;33(52):e346.
Perhimpunan Reumatologi Indonesia. Rekomendasi Perhimpunan Reumatologi Indonesia Untuk Diagnosis dan Pengelolaan Artritis Reumatoid. Jakarta: Perhimpunan Reumatologi Indonesia. 2014. 4-19.
Kay J, Upchurch KS. ACR/EULAR 2010 rheumatoid arthritis classification criteria. Rheumatology (Oxford). 2012 Dec;51 Suppl 6:vi5-9.
Sokka T, Hetland ML, Mäkinen H, Kautiainen H, Hørslev-Petersen K, Luukkainen RK, et al. Remission and rheumatoid arthritis: data on patients receiving usual care in twenty-four countries. Arthritis Rheum. 2008 Sep;58(9):2642-51.
Anderson J, Caplan L, Yazdany J, Robbins ML, Neogi T, Michaud K, Saag KG, et al. Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice. Arthritis Care Res (Hoboken). 2012 May;64(5):640-7.
Grigor C, Capell H, Stirling A, McMahon AD, Lock P, Vallance R, Kincaid W, Porter D. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomized controlled trial. Lancet. 2004 Jul 17-23;364(9430):263-9.
Pope JE, Haraoui B, Rampakakis E, Psaradellis E, Thorne C, Sampalis JS. Optimization of Adalimumab Trial Investigators. Treating to a target in established active rheumatoid arthritis patients receiving a tumor necrosis factor inhibitor: results from a real-world cluster-randomized adalimumab trial. Arthritis Care Res (Hoboken). 2013 Sep;65(9):1401-9.
Andréu JL, Martín MA, Corominas H, Pérez-Venegas JJ, Román-Ivorra JA, Sánchez-Alonso F, Gil de Miguel Á. Treat-to-Target Strategy in Patients with Rheumatoid Arthritis: Audit of Adherence from Real World Clinical Data. Reumatol Clin. 2019 Dec 24:S1699-258X(19)30166-4.
Smolen JS, Aletaha D, Bijlsma JW, Breedveld FC, Boumpas D, Burmester G, Combe B, et al. T2T Expert Committee. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010 Apr;69(4):631-7.
van der Linden MP, le Cessie S, Raza K, van der Woude D, Knevel R, Huizinga TW, van der Helm-van Mil AH. Long-term impact of delay in assessment of patients with early arthritis. Arthritis Rheum. 2010 Dec;62(12):3537-46.
Smolen JS, Aletaha D. Rheumatoid arthritis therapy reappraisal: strategies, opportunities and challenges. Nat Rev Rheumatol. 2015 May;11(5):276-89.
Emery P, Bingham CO 3rd, Burmester GR, Bykerk VP, Furst DE, Mariette X, et al. Certolizumab pegol in combination with dose-optimized methotrexate in DMARD-naïve patients with early, active rheumatoid arthritis with poor prognostic factors: 1-year results from C-EARLY, a randomized, double-blind, placebo-controlled phase III study. Ann Rheum Dis. 2017 Jan;76(1):96-104.
Li R, Zhao JX, Su Y, He J, Chen LN, Gu F, et al. High remission and low relapse with prolonged intensive DMARD therapy in rheumatoid arthritis (PRINT): A multicenter randomized clinical trial. Medicine (Baltimore). 2016 Jul;95(28):e3968.
Boers M, Verhoeven AC, Markusse HM, van de Laar MA, Westhovens R, van Denderen JC, van Zeben D, et al. Randomised comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone in early rheumatoid arthritis. Lancet. 1997 Aug 2;350(9074):309-18. doi: 10.1016/S0140-6736(97)01300-7. Erratum in: Lancet 1998 Jan 17;351(9097):220.
Landewé RB, Boers M, Verhoeven AC, Westhovens R, van de Laar MA, Markusse HM, van Denderen JC, et al. COBRA combination therapy in patients with early rheumatoid arthritis: long-term structural benefits of a brief intervention. Arthritis Rheum. 2002 Feb;46(2):347-56. doi: 10.1002/art.10083. PMID: 11840436.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Clinical and Research Journal in Internal Medicine

This work is licensed under a Creative Commons Attribution 4.0 International License.
The copyright of the received article shall be assigned to the journal as the publisher of the journal. The intended copyright includes the right to publish the article in various forms (including reprints). The journal maintains the publishing rights to the published articles.