Ajuste en la práctica clínica de las directrices treat-to-target para la artritis reumatoide: resultados del estudio ToARCan

Naranjo, Antonio; Cáceres, Laura; Hernández‐Beriain, José Ángel; Francisco, Félix; Ojeda, Soledad; Talaverano, Sigrid; Nóvoa-Medina, Javier; Martín, José Adán; Delgado, Esmeralda; Trujillo, E.; Álvarez, Fátima; Magdalena, Laura; Rodríguez‐Lozano, Carlos

doi:10.1016/j.reuma.2015.03.003

Cited by 3 publications

(7 citation statements)

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“…Por otro lado, el tratamiento por objetivos no tendría que implicar necesariamente la aplicación de terapias más costosas. De hecho, se podría llegar a disminuir el uso de las terapias biológicas gracias a la mejora en el empleo de las terapias convencionales [88,89] .…”

Section: Alternativa Propuestaunclassified

“…La inversión necesaria para utilizar las estrategias Treat to Target y control estrecho, implicaría el coste de tres visitas adicionales a reumatología así como tres visitas adicionales a enfermería hospitalaria (dos presenciales y una telefónica) hasta alcanzar baja actividad, puesto que con seis visitas anuales sería suficiente [5] y actualmente se dan tres de media [88] .  Se reducirían los costes sanitarios gracias a que los pacientes con AR precoz alcanzarían remisión según criterios DAS28 [87] .…”

Section: Alternativa Propuestaunclassified

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SROI-AR. Impacto clínico, asistencial, económico y social del abordaje ideal de la artritis reumatoide en comparación con el abordaje actual

Merino¹,

Ivanova²,

Gómez³

et al. 2019

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Impacto clínico, asistencial, económico y social del abordaje ideal de la Artritis Reumatoide en comparación con el abordaje actual-Proyecto SROI-AR] INFORME FINAL 5 [Impacto clínico, asistencial, económico y social del abordaje ideal de la Artritis Reumatoide en comparación con el abordaje actual-Proyecto SROI-AR] INFORME FINAL 9.4 Propuestas del área de AR precoz _______________________________________ 9.4.1 Propuesta 6. Estrategias Treat to Target y control estrecho. Tratamiento precoz con FAME tras diagnóstico __________________________________________________ 9.4.2 Propuesta 7. Consensuar el plan terapéutico (farmacológico y no farmacológico) con el paciente _____________________________________________________________ 9.4.3 Propuesta 8. Accesibilidad sin cita al especialista ante brotes o descompensaciones _ 9.4.4 Propuesta 9. Consultas propias de enfermería en reumatología en AR precoz ______ 9.4.5 Propuesta 10. Formación sobre adherencia y uso de los medicamentos para los pacientes con AR precoz ________________________________________________ 9.4.6 Propuesta 11. Formación y adherencia en aspectos no farmacológicos ligados a la enfermedad para los pacientes con AR precoz _______________________________ 9.4.7 Propuesta 12. Abordaje asistencial integral de otros aspectos intangibles _________ 9.4.8 Resumen de la inversión y del retorno en el área de AR precoz __________________ 9.5 Propuestas del área de AR establecida ___________________________________ 9.5.1 Propuesta 13. Estrategias Treat to Target y control estrecho ____________________ 9.5.2 Propuesta 14. Coordinación entre atención primaria y atención especializada para el tratamiento y seguimiento del paciente ____________________________________ 9.5.3 Propuesta 15. Equidad en el acceso a todos los fármacos disponibles comercializados ___________________________________________________________________ 9.5.4 Propuesta 16. Consultas propias de enfermería en reumatología en AR establecida 9.5.5 Propuesta 17. Formación sobre adherencia y uso de los medicamentos para los pacientes con AR establecida____________________________________________ 9.5.6 Propuesta 18. Formación y adherencia en aspectos no farmacológicos ligados a la enfermedad para los pacientes con AR establecida __________________________ 9.5.7 Propuesta 19. Ampliación del horario de atención especializada ________________ 9.5.8 Propuesta 20. Abordaje integral multidisciplinar e individualizado, asegurando el contacto con otros profesionales sanitarios ________________________________ 9.5.9 Propuesta 21. Fomentar el papel de las asociaciones como elemento complementario a las prestaciones del Sistema Nacional de Salud ____________________________ 9.5.10 Propuesta 22. Atención a la discapacidad: coordinación socio-sanitaria y soporte social general _____________________________________________________________ 9.5.11 Resumen de la inversión y del retorno en el área de AR establecida _____________ 9.6 Ratio SROI _________________________________________________________ 9.7 Análisis de sensibilid...

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Section: Alternativa Propuestaunclassified

SROI-AR. Impacto clínico, asistencial, económico y social del abordaje ideal de la artritis reumatoide en comparación con el abordaje actual

Merino¹,

Ivanova²,

Gómez³

et al. 2019

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“…Treatment seeks to achieve and maintain ‘remission’ or, at least, minimal disease activity. Recent changes in the management of RA have improved the clinical course of the disease 1. The ‘window of opportunity’ concept2–4 underscores the need to initiate aggressive treatment early in the disease process and thus improve prognosis.…”

Section: Introductionmentioning

confidence: 99%

Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease

et al. 2023

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ObjectivesMost studies on difficult-to-treat rheumatoid arthritis (D2T RA) have focused on established RA. Here, we analyse whether disease activity in the early stages of RA could influence progression to a D2T RA under real-life conditions. Other clinical and treatment-related factors were also analysed.MethodsA longitudinal multicentre study of patients with RA was conducted from 2009 to 2018. Patients were followed up until January 2021. D2T RA was defined based on EULAR criteria (treatment failure, signs suggestive of currently active/progressive disease and management being perceived as problematic by the rheumatologist and/or patient). The main variable was disease activity in the early stages. The covariates were sociodemographic, clinical and treatment-related factors. We ran a multivariable logistic regression analysis to investigate risk factors associated with progression to D2T RA.ResultsThe study population comprised 631 patients and 35 (5.87%) developed D2T RA. At the time of diagnosis, the D2T RA group were younger, with a higher disability, 28-joint Disease Activity Score (DAS28) score, tender joint count and pain scores. In our final model, DAS28 was not statistically significantly associated with D2T RA. No differences were found between groups for therapy. Disability was independently associated with D2T RA (OR: 1.89; p=0.01).ConclusionsIn this cohort of patients newly diagnosed with RA, our results do not allow us to prove the influence of active disease according to DAS28. However, we did find that younger patients and those with elevated initial disability scores are more likely to develop D2T RA regardless of other factors.

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“…Treatment seeks to achieve and maintain “remission” or, at least, minimal disease activity. Recent changes in the management of RA have improved the clinical course of the disease (1). The “window of opportunity” concept (2)(3)(4) underscores the need to initiate aggressive treatment early in the disease process and thus improve prognosis.…”

Section: Introductionmentioning

confidence: 99%

“…Recommendations on the management of RA have come to include continuous supervision and monitoring of disease course and associated comorbidity (9)(10), thus enabling remission and low disease activity in clinical practice (1). The prevalence of remission in RA patients is reported to be around 30% (11)(12).…”

Section: Introductionmentioning

confidence: 99%

Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease

León

Madrid

Lopez-Viejo

et al. 2022

Preprint

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Objectives. Most studies on difficult-to-treat rheumatoid arthritis (D2T RA) have focused on established RA. Here, we analyze whether disease activity in the early stages of RA could influence progression to a D2T RA under real-life conditions. Other clinical and treatment-related factors were also analyzed. Methods. A longitudinal multicenter study of RA patients was conducted from 2009 to 2018. Patients were followed up until January 2021. D2T RA was defined based on EULAR criteria (treatment failure, signs suggestive of currently active/progressive disease, and management being perceived as problematic by the rheumatologist and/or patient). The main outcome was disease activity in the early stages. The covariates were sociodemographic, clinical, and treatment-related factors. We ran a multivariable logistic regression analysis to investigate risk factors associated with progression to D2T RA. Weighting techniques were also applied to balance data. Results. The study population comprised 631 patients and 35 developed D2T RA. At the time of diagnosis, the D2T RA group were younger, with a higher disability, DAS28 score, tender joint count and pain scores. In our final model, DAS28 was not statistically significantly associated with D2T RA. No differences were found between groups for therapy. Disability was independently associated with D2T RA (OR: 1.50; p=0.02). Conclusions. In this cohort of patients newly diagnosed with RA, our results do not allow us to prove the influence of active disease according to DAS28. However, we did find that patients with elevated initial disability scores are more likely to develop D2T RA regardless of other factors.

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Ajuste en la práctica clínica de las directrices treat-to-target para la artritis reumatoide: resultados del estudio ToARCan

Cited by 3 publications

References 13 publications

SROI-AR. Impacto clínico, asistencial, económico y social del abordaje ideal de la artritis reumatoide en comparación con el abordaje actual

SROI-AR. Impacto clínico, asistencial, económico y social del abordaje ideal de la artritis reumatoide en comparación con el abordaje actual

Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease

Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease

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