RESEARCH - Tight enough? Implementing TICORA in an early arthritis clinic

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ACR/ARHP 2008 Scientific Meeting

1008 - Tight Enough? Implementing TICORA in an Early Arthritis Clinic

Pres. Time: Monday, Oct 27, 2008, 9:00 AM -11:00 AM

Location: Hall A, Poster Board: 269

Category: 17. RA: clinical aspects

Author(s): Dale, Joan , Gupta, Duncan Porter.

Gartnavel General Hospital, Glasgow, United Kingdom

Abstract:

Introduction

The TICORA trial showed that intensive management of early RA is

associated with significant improvements in outcome compared to

routine care1. We describe our experiences of starting an 'early RA'

clinic, based on the principles of TICORA, to identify whether the

benefits can be replicated in routine clinical practice.

Methods

All patients with newly diagnosed RA attend an 'early RA' clinic every

4-6 weeks up to the first year after diagnosis. At each consultation,

disease activity is assessed (DAS28), and persistent disease activity

(DAS28>3.2) is treated by optimising DMARD therapy, using a protocol

based on the TICORA regimen, and a combination of IM and IA

triamcinolone. Initial monotherapy is with either methotrexate (MTX)

or sulfasalazine (SSZ). After 3 months, patients 'step-up' to triple

therapy with MTX, SSZ and hydroxychloroquine if DAS28 remains greater

than 3.2

Demographic and disease characteristic data are collected at

presentation. Data regarding ongoing disease activity, DMARD treatment

changes and triamcinolone injections is collected prospectively.

Patients in sustained remission (DAS28 < 2.6), or who complete 12

months follow-up, are transferred to routine care and are included in

this analysis. Primary outcome measures were DAS28 and EULAR response

rates

Results

108 case records were available for review. 90 (83%) patients were

diagnosed with RA and 18 (14.8%) with undifferentiated polyarthritis.

Mean age was 55 years, 73% were female. 72% had positive rheumatoid

factor (mean titre = 394 iu/ml). 34% had erosive disease. Mean period

between reviews was 1.2 months and 61 patients had been followed for

12 months or had been discharged to the routine clinic.

Mean baseline DAS28 = 5.57. Mean end point DAS28 = 3.2. Mean change in

DAS28 = 2.29. At their final visit, 48% of patients were in remission

(Table 1).

By endpoint, 48% patients were on DMARD monotherapy, 46% on

combination therapy (30% duotherapy, 16% triple therapy) and 7% on

biologic therapy. SSZ was more likely to be discontinued than MTX (18%

vs 3%). Mean total IA triamcinolone dose was 130mg, mean total IM dose

was 165.8mg

Conclusions

Intensive management of early RA in routine clinical practice was

associated with significant improvements in disease activity. Our

final remission rate of 48% was comparable to the 12 month rate of 44%

reported by TICORA. However, a significant proportion of patients

still have evidence of persistent disease activity, and some patients

were likely under-treated according to the management protocol.

http://www.abstractsonline.com/plan/start.aspx?mkey=5880E483-F47E-4EFF-A557-2EF1\

43592815

Presentation 1008

Not an MD