Introduction: Although Rheumatoid arthritis (RA) is the most common type of autoimmune arthritis that can lead to chronic disability and deformities, the overall benefit of intensive treatment strategies in rheumatoid arthritis remains uncertain. RA often causes pain and swelling in the wrist and small joints of the hand and feet. DAS28 score in RA of greater than 5.1 implies active disease, less than 3.2 low disease activities, and less than 2.6 remissions. Adequate treatment not only controls the symptoms but also may prevent joint damage and deformities.
Objective/Aim: To understand clinic-epidemiology of RA and value of applying DAS28-ESR scores in monitoring disease activity in a “treat to target” strategy before, during and after treatment for making timely treatment decisions.
Materials and Method: We longitudinally studied confirmed cases of Adult RA (n = 44) in a tertiary care teaching hospital located in the North-eastern region of India ACR/EULAR (2010) classification criteria were used for case definition. Patients with advanced stage disease were excluded. Baseline DAS28- ESR score was calculated. The target was to achieve and maintain a target DAS28-ESR of 3.2 or improve score by at least 1.2 within 3-6 Months. Patient-centric physiotherapy and occupation therapy were added to the regime. After six months of intensive treatment targets with DMARDs and symptom modifying agents, final endpoint DAS28-ESR data were compared to baseline scores to measure treatment outcomes.
Results: The cohort was dominated by females between 30-55 years of age with M/F ratio 1.17: 4. Nearly 85% were seropositive RA. The average baseline DAS28-ESR score was 5 indicating aggressive RA cohort. The change in the average score by 2.27 after intensive treatments with DAS28-ESR targets was impressive for further treatment decisions. Thirty out of 44 had DAS28 <3.2. Indicating low disease activity and 27/44 had score <2.6 indicating remission.
Conclusion: Intensive treatment in RA with a treat to target strategy to bring objective change in DAS28 score was generally well-tolerated and it complemented well with the concept of early intensive treatment according to inverted pyramid model for timely optimization of appropriate regime and lower likelihood of joint damage and disease progression.
Keywords: Rheumatoid arthritis (RA), DAS28 (Disease activity score), ESR (Erythrocyte sedimentation rate), DMARDs (Disease modifying anti-rheumatoid drugs)
