Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Treating Rheumatoid Arthritis to Target: Multinational Recommendations Assessment Questionnaire.
Haraoui13, Boulos, Smolen18, Josef S., Aletaha21, Daniel, Breedveld4, Ferdinand C., de Wit25, Maarten, Dougados8, Maxime, Emery2, Paul
Center of Rheumatic Diseases, Bucharest, Romania
Hospital Militar Central, Bogota, Colombia
Hospital Santa Maria, Lisboa, Portugal
Instanbul University, Cerrahpasa Medical School, Istanbul, Turkey
Institut de Rhumatologie, Montreal, QC, Canada
Institute for Clinical Immunology, Erlangen, Germany
Institute of Rheumatology, Warszawa, Poland
IRCCS Policlinico S Matteo, Pavia, Italy
Keio University, Toyko, Japan
Krankenhaus Lainz, Vienna, Austria
Leiden University Medical Center, Meerssen, The Netherlands
Chapel Allerton Hospital, Leeds, United Kingdom
Medical University of Graz, Graz, Austria
Medical University of Vienna, Vienna, Austria
National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
Universite Catholique de Louvain, Brussels, Belgium
University of Coimbra, Protuga, Algés, Portugal
VU Medical Centre, Department of Medical Humanities, Amsterdam, The Netherlands
Charite-University Medicine, Berlin, Germany
Dept. of Rheumatology, Leiden University, Medical Centre, Leiden, The Netherlands
Diakonhjemmet Hospital, Oslo, Norway
Division of Rheumatology, University of Sao Paolo, Brazil
Facultad de Ciencias Medicas y Bioplogicas Dr. Ignacio Chavez UMSNH, Morelia, Michoacan, Mexico
Hospital Cochin, Paris, France
Hospital for Special Surgery, New York, NY
An international survey was conducted to measure the level of agreement and application of the 10 recommendations developed by the Treat to Target initiative (Smolen JS, et al. Ann Rheum Dis. 2010), aimed at defining therapeutic goals and achieving optimal outcomes for rheumatoid arthritis (RA).
A10-point Likert items scale (1 = fully disagree, 10 = fully agree) measured the level of agreement with each of 10 recommendations. A 4-point Likert items scale (1 = never, 2 = not very often, 3 = very often, 4 = always) assessed the degree to which each recommendation was being applied in current daily practice. If responders answered "never" or "not very often", they were asked whether they would change their practice according to the particular recommendation.
1568 physicians, representing 33 countries, participated. Practices in University hospitals, general hospitals, and private clinics were well represented, with 37%, 31%, and 21% of respondents, respectively. Years in practice ranged from 0 to 52 years (mean 18+/-10.72. Both agreement with and application of the recommendations were high. Recommendations #1 ("The primary target for treatment of RA should be a state of clinical remission") and #10 ("The patient has to be appropriately informed about the treatment target and the strategy planned to reach this target under the supervision of the rheumatologist") received the highest agreement scores of 9.156 and 9.272, respectively. Recommendations #5 ("Measures of disease activity must be obtained and documented regularly, as frequently as monthly for patients with high/moderate disease activity or less frequently [such as every 3 to 6 months] for patients in sustained low disease activity or remission") and #3 ("While remission should be a clear target, based on available evidence low disease activity may be an acceptable alternative therapeutic goal, particularly in established long-standing disease") received the lowest agreement scores, 8.445 and 8.515, respectively, although these are still very high. In regard to application of recommendations in daily practice, the majority of responses were "always" and "very often". However, recommendation #5 also received the highest number of "never" or "not very often" responses (12.43%). Of the participants who were currently not applying these recommendations in clinical practice, many (36.27% to 68.18% depending on the recommendation) were willing to change practice according to the recommendations. However, 38.92% of participants not applying recommendation #5 indicated they would not change their practice.
The results of this survey demonstrated great support of "Treating RA to Target" recommendations amongst the international rheumatology community. Since these recommendations are based on evidence and consensus, additional efforts may be needed to encourage their application also amongst clinicians who are hesitant to change their practice.
Funding for this initiative was provided through Abbott Laboratories.
To cite this abstract, please use the following information:
Haraoui, Boulos, Smolen, Josef S., Aletaha, Daniel, Breedveld, Ferdinand C., de Wit, Maarten, Dougados, Maxime, et al; Treating Rheumatoid Arthritis to Target: Multinational Recommendations Assessment Questionnaire. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1013