Patient perspectives on achieving treat-to-target goals: a critical examination of patient-reported outcomes

UMMS Affiliation

Department of Orthopedics and Physical Rehabilitation; Department of Medicine, Division of Preventive and Behavioral Medicine



Document Type


Medical Subject Headings

Adult; Aged; Antirheumatic Agents; Arthritis, Rheumatoid; Biological Products; Disability Evaluation; Disease Progression; Female; *Health Knowledge, Attitudes, Practice; Humans; Least-Squares Analysis; Male; Middle Aged; Multivariate Analysis; Pain Measurement; Patients; *Perception; Predictive Value of Tests; Remission Induction; *Self Report; Severity of Illness Index; Time Factors; Treatment Outcome


Musculoskeletal Diseases | Rheumatology


OBJECTIVE: Treat-to-target (T2T) recommendations suggest that rheumatoid arthritis (RA) patients should strive for remission or low disease activity (LDA). However, it is unclear whether patients experiencing a good response to biologic agents might experience further improvement in patient-reported outcomes (PROs) if they subsequently achieve a lower disease activity state, particularly the T2T goals of LDA or remission.

METHODS: Using the Consortium of Rheumatology Researchers of North America database, we identified RA patients initiating biologic agents. We restricted the analysis to patients with improvement (Clinical Disease Activity Index [CDAI] improvement of >/=10 units) at 3-6 months (baseline visit; n = 1,368) with a followup visit approximately 9 months later (n = 984). Patients in CDAI remission or with a worsened disease activity category were excluded, leaving 562 eligible patients. PROs (global assessment, pain, and fatigue by 0-10 visual analog scales and disability by the modified Health Assessment Questionnaire [M-HAQ]) were examined at these 2 visits. Mean change in PROs compared achievement of a lower disease activity category versus staying in the same disease activity category, adjusting for potential confounders.

RESULTS: Patients who achieved a lower disease activity category (40% of the eligible cohort, 86% of these achieving LDA or remission) had significantly better improvement in patient pain (-14.9; 95% confidence interval [95% CI] -18.4, -11.6), patient global (-17.5; 95% CI -20.8, -14.3), fatigue (-8.5; 95% CI -15.8, -1.3), and M-HAQ score (-0.13; 95% CI -0.18, -0.08) compared to patients who stayed in the same disease activity category. However, even for patients improving, fewer than half exceeded the minimum clinically important difference for each PRO.

CONCLUSION: Achievement of a lower disease activity disease state, especially T2T goals, was associated with further improvement in PROs, albeit modest in magnitude.


Citation: Curtis, J. R., Shan, Y., Harrold, L., Zhang, J., Greenberg, J. D. and Reed, G. W. (2013), Patient Perspectives on Achieving Treat-to-Target Goals: A Critical Examination of Patient-Reported Outcomes. Arthritis Care Res, 65: 1707–1712. doi: 10.1002/acr.22048. Link to article on publisher's site

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