Vol.:(0123456789) 1 3 Rheumatol Int DOI 10.1007/s00296-017-3695-4 OBSERVATIONAL RESEARCH Long-term outcomes of treat-to-target strategy in established rheumatoid arthritis: a daily practice prospective cohort study Nicole Pamplona Bueno de Andrade 1,2  · Rafael Mendonça da Silva Chakr 1,2  · Ricardo Machado Xavier 1,2  · Daniela Viecceli 1  · Ricardo Henrique Bilycz Correa 1  · Cilomar Martins de Oliveira Filho 1  · Claiton Viegas Brenol 1,2   Received: 6 September 2016 / Accepted: 4 March 2017 © Springer-Verlag Berlin Heidelberg 2017 therapeutic options, in the scenario of T2T strategy, was associated with improvement in disease activity and physi- cal function. Keywords Rheumatoid arthritis · Established rheumatoid arthritis · Treat-to-target · Cohort study Introduction The term ‘established RA’ is generally used to describe patients with disease duration of 2 years or more. A large proportion of current clinical practice involves the assess- ment and management of patients with established disease, which comprises both patients whose disease was recog- nized at an early stage in whom treatment with DMARDs has been largely efective, and patients with long-standing disease with consequences of chronic infammation [1]. Treat-to-target (T2T) has become a landmark strategy to be pursued in every patient with rheumatoid arthritis (RA). This strategy has been extensively studied in patients with early disease. Compared to usual care, T2T has been shown to decrease radiographic progression and improve quality of life and physical function [2]. Recently updated recom- mendations suggest that clinical remission should be the primary target for treatment, although low-disease activity (LDA) may be an alternative goal in long-standing disease [3]. LDA may be a more realistic target in patients with a high burden of erosive disease and co-morbidities preclud- ing aggressive therapy. In the last decade, few studies have addressed the impact of a T2T strategy in patients with established RA [4–8]. They demonstrate conficting results regarding clinical and functional improvements and most of them evaluate patients only under synthetic DMARD Abstract To examine disease activity and physical func- tion after implementation of treat-to-target (T2T) strategy in patients with established rheumatoid arthritis (RA) over a long-term period. Patients with RA were started on a T2T strategy in 2005 and followed through 2014. Patients were seen every 3–4 months until remission/low disease activity was achieved and every 6 months thereafter. Dis- ease activity was measured by the DAS28 and CDAI, and physical function by the HAQ-DI. Results were presented as all observed data, without imputation for missing val- ues. Changes in disease activity and physical function were evaluated by generalized estimating equations (GEE). Two hundred and twenty-nine patients were included, with a mean (SD) disease duration of 10.6 (7.4) years. Signifcant improvements were seen in both composite scores during the follow-up period, as demonstrated by DAS28 (β coef- fcient = 0.19; 95% CI = 0.16–0.21; p < 0.01) and by CDAI (β coefcient = 1.59; 95% CI = 1.84–1.34; p < 0.01). Physi- cal function also improved, as demonstrated by HAQ-DI (β coefcient = 0.03; 95% CI = 0.02–0.04; p < 0.01). Bio- logical therapy was associated with improvement in dis- ease activity and in physical function. Lefunomide was only associated with improvement in physical function. Clinically meaningful reductions of DAS28, CDAI and HAQ-DI were observed in patients with established rheu- matoid arthritis from 2005 to 2014. Implementation of new Rheumatology INTERNATIONAL * Nicole Pamplona Bueno de Andrade nandrade@hcpa.edu.br 1 Department of Internal Medicine, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, Porto Alegre, RS 90035-002, Brazil 2 Rheumatology Division, Hospital de Clínicas (HCPA), Rua Ramiro Barcelos, 2350/645, Porto Alegre, RS 90035-903, Brazil