Rheumatoid arthritis

Treat-to-target uptake low in rheumatology clinics

Tuesday, 30 May 2017

Half of all rheumatologists in public and private practice in Australia do not apply the evidence based treat-to-target strategy when treating RA patients, a nationwide survey reveals.

Presenting the results of the survey to delegates at the joint Australian Rheumatology Australia and New Zealand congress here in Auckland Dr Helen Benham from the University of Queensland said that although the evidence for TTT was strong it was difficult to implement in every day practice.

“Where you and I see patients outside of randomised controlled trials or highly specialised clinic there are many challenges to undertaking a treat-to-target approach in RA. Therefore an evidence/practice gap that has emerged,” she told delegates.

The survey involving 85 rheumatologists found a general level of agreement on the use of the strategy in every day practice (7.05 to 9.32 on a 10 point Likert scale) but a lower level of agreement on the calculation of a composite disease activity score.

About 50 percent of rheumatologists said they used a disease activity score “very often” or “always” in their patients with RA.

The survey also found that 44% of respondents did not believe a TTT strategy was necessary for every patient with RA.

Time, patient acceptance, the availability of appointments and lack of access to a rheumatology nurse were considered by rheumatologists to be the biggest barriers to implementing the strategy, which is endorsed by EULAR and ACR guidelines.

A concurrent survey of 107 patients attending public and private clinics in Brisbane revealed that only 9 percent were aware of a treat-to-target concept and 88 percent said they would like to try the approach.

Dr Benham said the survey results had helped the research team to frame the remaining components of the project

“It’s helped us to think about how we can alter practice for clinicians, as well as the awareness and potential role change for people living with RA,” she said.

The researchers now aim to develop a knowledge translation tool which can be used at the point of care by the patient to discuss treat to target strategy with their rheumatologist.


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