Tight control of rheumatoid arthritis: Efficacy in a resource constrained setting

Abstract

Objectives: This study was designed to evaluate the efficacy of a treatment strategy based on the “tight control” principle in patients with Rheumatoid Arthritis (RA) with a one year follow up and in a limited resource setting..
Method: This was a « before-after » observational study, comparing disease activity and handicap in the same patient throughout the year 2018 (before) and 2019 (after). This assessment was based on the « tight control » principle and performed in a rheumatology outpatient setting in patients who met the 2010 ACR/EULAR classification criteria for RA. Disease activity was assessed using DAS28-CRP, SDAI, CDAI disease activity scales and disability using the HAQ. disability index.
Results: Of the fifty patients, 47 (97%) were female and 3(6%) male. The average number of outpatient visits was 2.34 ± 1.21 with extremes of 1 and 5 in 2018 and 3.94 ± 1.6 with extremes of 1 and 8 in 2019 (p < 0.0001). The frequency of patients in remission before and after the tight control strategy was 4% (before) and 48% (after) respectively according to DAS28-CRP (p<0.0001), 2% (before) and 12% (after) according to SDAI (p<0.0001) and 2% (before) and 16% (after) according to CDAI (p<0.0001). The mean HAQ was of 1.18 ± 0.58 (before) and 0.35 ± 0.25 (after) (p<0.0001).
Conclusion: The “tight control” treatment strategy resulted in a significant reduction in disease activity and handicap in the
majority of RA patients in a real life limited resource setting.