Missed Rheumatoid Arthritis Treatment Targets Challenge Physicians

Allison Shelley

October 23, 2018

Senior investigator Jeffrey Curtis, MD, from the University of Alabama at Birmingham, speaking at a news conference here at ACR 2018. (Camera work by John Gress; video edit by John Rodriguez)

CHICAGO — Patients treated for rheumatoid arthritis (RA) often receive a prescription and stick with it for more than a year, even if that treatment is not entirely working for them, according to a study presented here at the American College of Rheumatology (ACR) 2018 Annual Meeting

Both the ACR and the European League Against Rheumatism (EULAR) recommend routine measurement of RA disease activity so that treatment can be adjusted with the goal of lower disease activity or remission.

Investigators wanted to know whether the patients of rheumatologists who say they follow treat-to-target guidelines are achieving lower disease activity or remission.

For their study, investigator Jeffrey Curtis, MD, from the University of Alabama at Birmingham, and his colleagues used the RISE registry, the first and largest national electronic health-record-enabled rheumatology registry in the United States, to look at the treatment regimens of more than 50,000 patients.

Curtis explains the advantages of the Rheumatology
Informatics System for Effectiveness (RISE) registry.

Patients were assessed at the index visit with either the RAPID3 index or the Clinical Disease Activity Index (CDAI). Then, 7 to 12 months later, changes in disease activity and treatment were assessed.

The team found that for 50% of patients, medication remained unchanged over the follow-up period, despite moderate to high disease activity. The treatment least likely to be altered was the combination of methotrexate and a biologic.

Treatment Changes in Patients With Moderate to High Disease Activity at Index Visit
Change RAPID3, % (n = 2336) CDAI, % (n = 904)
Add or switch biologic 29 36
Add or switch DMARD 19 20


"I'm delighted the rate wasn't worse, but there is room for improvement," Curtis acknowledged.

In oncology, patients are accustomed to seeking treatment until remission, he pointed out. A similar standard should be set for rheumatic diseases; patients should have higher expectations.

But not all patients want to make bold treatment moves. "We need to take a step back and acknowledge that patients are diverse and not everyone is ready to make changes," said Cianna Leatherwood, MD, from Kaiser Permanente Oakland Medical Center in California.

In another presentation during the same session, senior investigator Patrick Durez, MD, from the Université Catholique de Louvain in Brussels, made the case for biologic tapering after patients with RA achieve low disease activity: "Tapering can be successful, reduce drug costs, and spare side effects."

The RISE analysis was funded by Eli Lilly. Curtis reports financial relationships with Eli Lilly, AbbVie, Amgen, BMS, Corrona, Genentech, Janssen, Myriad, Pfizer, Radius, Roche, and UCB.

American College of Rheumatology (ACR) 2018 Annual Meeting: Abstract 2856 presented October 23, 2018; abstract 625 presented October 21, 2018.

Follow Medscape Rheumatology on Twitter @MedscapeRheum and Allison Shelley @allishelley


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