0434: The advantage of a “tight control” and “treat-to-target” strategy in new-onset rheumatoid arthritis patients in daily rheumatology practice

Background/Purpose: Since 2021, patients with new-onset rheumatoid arthritis (RA) at the Department of Rheumatology, Skåne University Hospital, Lund, Sweden, are invited to participate in a ”tight control” and ”treat-to-target” (TC+T2T) follow-up strategy (TINDRA study). This strategy includes follow-up visits to a rheumatologist (at diagnosis and 3, 6, 12, 18, 24 months) and rheumatology nurse-led physical/telephone consultations between physician visits every other week for 3 months and thereafter when needed. Visits include disease activity assessments and adjustment of anti-rheumatic treatment when needed, aiming for remission. The aim of the current study was to explore possible advantages of implementing this TC+T2T strategy over routine clinical practice in new-onset RA patients regarding achievement of remission (DAS28 < 2,6, DAS28CRP < 2,4, CDAI≤2,8, and remission defined as 0 swollen joints in the 28-joint count score [“0 swollen joints of 28” remission]).

Methods: RA patients with symptom duration < 12 months at diagnosis were eligible. Data on disease-, treatment characteristics and outcome measures for patients included in the TINDRA study and controls were retrieved from the Swedish Rheumatology Quality register (SRQ). Controls comprised early RA patients followed according to routine clinical practice at the rheumatology out-patient clinics elsewhere in the Skåne region during the same period. In total, 103 patients were followed according to the TC+T2T strategy and 740 according to routine care. Achievement of remission at 1 year after diagnosis was compared between the two strategies using logistic regression, adjusted for sex, age, symptom duration, number of swollen and tender joints, CRP, ACPA status and HAQ at diagnosis.

Results: Disease and treatment characteristics at diagnosis are summarized in Table1.
Percentage females/mean age/mean symptom duration at inclusion were 73%/58 years/5,9 months (TC+T2T) and 69%/60 years/5,7 months (routine care).

Figure 1 illustrates proportion (%) of patients reaching remission (green area) according to the “0 swollen joints of 28” definition at different follow-up times in patients and controls.

Percentages of patients reaching DAS28, DAS28CRP and CDAI remission criteria increased in both groups over time, but the differences between the TC+T2T strategy and routine care were not significant. However, at 12 months of follow-up, the TC+T2T strategi was associated with significantly higher odds of reaching “0 swollen joints of 28” remission compared to routine care (Table2).

Conclusion: Compared to routine rheumatology care, the “tight control” and ”treat-to-target” follow-up strategy resulted in larger proportions of patients reaching remission throughout the first two years after RA diagnosis and a more than doubled probability of reaching the strict target of “no swollen joints” one year following the diagnosis. These findings suggest that such a strategy should be considered for implementation in routine care of patients with new-onset RA.