Rheumatologists’ adherence to a disease activity score steered treatment protocol in early arthritis patients is less if the target is remission

G. Akdemir, I. M. Markusse, Y. P.M. Goekoop-Ruiterman, G. M. Steup-Beekman, B. A.M. Grillet, P. J.S.M. Kerstens, W. F. Lems, T. W.J. Huizinga, C. F. Allaart

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11 Citations (Scopus)


To compare rheumatologists’ adherence to treatment protocols for rheumatoid arthritis (RA) targeted at Disease Activity Score (DAS) ≤2.4 or <1.6. The BeSt-study enrolled 508 early RA (1987) patients targeted at DAS ≤2.4. The IMPROVED-study included 479 early RA (2010) and 122 undifferentiated arthritis patients targeted at DAS <1.6. We evaluated rheumatologists’ adherence to the protocols and assessed associated opinions and conditions during 5 years. Protocol adherence was higher in BeSt than in IMPROVED (86 and 70 %), with a greater decrease in IMPROVED (from 100 to 48 %) than in BeSt (100 to 72 %). In BeSt, 50 % of non-adherence was against treatment intensification/restart, compared to 63 % in IMPROVED and 50 vs. 37 % were against tapering/discontinuation. In both studies, non-adherence was associated with physicians’ disagreement with DAS or with next treatment step and if patient’s visual analogue scale (VAS) for general health was ≥20 mm higher than the physician’s VAS. In IMPROVED, also discrepancies between swelling, pain, erythrocyte sedimentation rate, and VASgh were associated with non-adherence. Adherence to DAS steered treatment protocols was high but decreased over 5 years, more in a DAS <1.6 steered protocol. Non-adherence was more likely if physicians disagreed with DAS or next treatment step. In the DAS <1.6 steered protocol, non-adherence was also associated with discrepancies between subjective and (semi)objective disease outcomes, and often against required treatment intensification. These results may indicate that adherence to DAS-steered protocols appears to depend in part on the height of the target and on how physicians perceive the DAS reflects RA activity.

Original languageEnglish
Pages (from-to)317-326
Number of pages10
JournalClinical Rheumatology
Issue number2
Publication statusPublished - 1 Feb 2017


  • DAS steered protocols
  • Early rheumatoid arthritis
  • Physician
  • Protocol adherence
  • Treatment target

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