Practising computer-aided objectified outcome-driven targeted treatment of rheumatoid arthritis in a resource constrained country: results from a single rheumatology clinic

Aims & ObjectivesThe aim of the study was to test the feasibility of carrying out objectified assessment at each patient visit in a busy rheumatology clinic using a dedicated rheumatology software, adjusting the treatment accordingly to achieve predetermined outcome target of disease activity. The objective was to assess the results of targeted treatment to see if this method of RA treatment achieved better results than those by routine-care treatment that the patients received in the immediate past before coming to this clinic.Patients and MethodsRA patients presenting from 1-7-07 to 30-6-09 were included. Specialized rheumatology software (Medic-Aid Rheumatology®) was used for data recording, disease assessment and prescription writing. Details of past-health care providers, the type of treatment taken, method used for measuring treatment outcome were recorded at the first clinic visit. A pre-planned treatment protocol was used, guided by the DAS28 or CDAI values. The treatment response was statistically compared with the disease activity status at the first visit.ResultsStudy included 215 patients; 16% were having low disease activity or were in remission at the first presentation. Sixteen patients (7.4%) dropped out before adequate follow-up. The mean follow-up was for 37 (±12) weeks. Among 199 remaining patients, 83.4% had low disease activity or were in remission at the last follow-up visit. This difference was statistically highly significant.ConclusionUsing dedicated rheumatology software, it was feasible to carry out objectified assessment of the disease activity and functional status in every RA patient in real-time at each follow-up visit in a routine OPD setting. Objectified computer-aided assessment and outcome-driven targeted treatment with standard DMARDs achieved low disease activity/remission in a vast majority of patients. This could be a practical and highly effective treatment strategy for patients with RA in a resource-constrained country like ours.