Maintenance of lower disease activity levels in patients with rheumatoid arthritis through high adherence to appointments and treatment

Objective To describe persistence of the disease activity score (DAS28) low levels in patients with rheumatoid arthritis (RA) who received conventional and biological therapy in a multidisciplinary care model center (MCM) maintaining adherence to appointments and treatment. Material and methods A longitudinal observational study in patients with RA under a MCM model. Patients were followed-up at least six times a year to guarantee adherence to MCM and treatment. Using this approach, a cohort of RA patients were followed-up during 2018. Demographical and clinical data were extracted from the electronic health records. Descriptive statistics were calculated, and the association between clinical and demographic variables was studied by means of the Chi-square test and analyzed using the McNemar Bowker test if disease activity levels (remission, low, moderate, and high) changed in the patients during the study period. Results 2,239 RA patients were followed-up. 82.76% were women. The average disease duration was eight years (IQR: 3-18 years). The main clinical comorbidities were hypertension (23.4%) and osteoporosis (13.6%). During the follow-up year, 91.6% of patients with conventional therapy had at least six rheumatology appointments, and 86.9% for those who received biological therapy. There were no significant changes for each level of DAS28 from the first to the sixth appointment in patients with biological treatment. Nevertheless, in patients who received conventional therapy there was a significant increase of patients in remission level of DAS28 (p-value = 0.004). Conclusions MCM model and high levels of adherence to medical appointments guarantee keeping remission levels for RA. The persistence of low levels of disease activity in patients with rheumatoid arthritis was observed over time in a multidisciplinary care center. Meanwhile in patients with conventional treatment, a significant increase in remission levels is obtained, which emphasizes the importance of maintaining adherence to appointments and treatment in controlling the disease. Keywords Rheumatoid arthritis treatment, multidisciplinary care model, adherence.