Exploring treat-to-target strategies and monitoring of disease activity with the HandScan in rheumatoid arthritis

Abstract

Rheumatoid arthritis (RA) is a common inflammatory joint disease, which is characterized by inflammation of the synovial membrane. This can result in joint damage, declined physical function and reduced quality of life. To prevent this, guidelines recommend to treat patients with RA according to the tight-control and treat-to-target principles with the target of remission or low disease activity. The current thesis aimed to further improve care for patients with RA. The first part evaluates DMARD therapy approaches in treat-to-target treatment strategies in (early) RA, including (cost-)effectiveness and longer-term outcomes. The second part explores whether monitoring of disease activity can be performed accurately using objective reading of inflammation with the HandScan. Overall, PART I showed that more intensive treat-to-target treatment strategies are more effective compared to strategies initiating MTX monotherapy according to the current guidelines on short-term in early RA. However, adding GCs (e.g., as bridging therapy) might be equally effective compared to these more intensive strategies. Standard strategies with GC’s are more cost-effective, and widely available. The cost effectiveness of the more intensive strategies can be improved with a strict tapering protocol. In addition, it might be cost-effective in specific subgroups of patients, e.g., MTX non-responders. PART II showed that the HandScan can be used as an instrument to monitor disease activity in RA patients, if OST-scores are combined with other routinely collected parameters. The developed and validated index, DAS-OST, is an objective, quick and relatively cheap tool to assess disease activity in patients with RA.