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Does treatment strategy influence the ability to achieve and sustain DMARD-free remission in patients with RA? Results of an observational study comparing an intensified DAS-steered treatment strategy with treat to target in routine care
To study the impact of treatment strategy on achieving and sustaining disease-modifying antirheumatic drug (DMARD)-free remission in patients with rheumatoid arthritis (RA). Two hundred seventy-nine RA patients (median follow-up 7.8 years) were studied. Of these, 155 patients participated in a disea...
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| Published in: | Arthritis research & therapy 2019-05, Vol.21 (1), p.115-10, Article 115 |
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| creator | Burgers, L E van der Pol, J A Huizinga, T W J Allaart, C F van der Helm-van Mil, A H M |
| description | To study the impact of treatment strategy on achieving and sustaining disease-modifying antirheumatic drug (DMARD)-free remission in patients with rheumatoid arthritis (RA).
Two hundred seventy-nine RA patients (median follow-up 7.8 years) were studied. Of these, 155 patients participated in a disease activity score (DAS) |
| doi_str_mv | 10.1186/s13075-019-1893-z |
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Two hundred seventy-nine RA patients (median follow-up 7.8 years) were studied. Of these, 155 patients participated in a disease activity score (DAS) < 1.6 steered trial aimed at DMARD-free remission. Initial treatment comprised methotrexate with high-dose prednisone (60 mg/day) and a possibility to start biologicals after 4 months. In the same period and hospital, 124 patients were treated according to routine care, comprising DAS < 2.4 steered treatment. Percentages of DMARD-free remission (absence of synovitis for ≥ 1 year after DMARD cessation), late flares (recurrence of clinical synovitis ≥ 1 year after DMARD cessation), and DMARD-free sustained remission (DMARD-free remission sustained during complete follow-up) were compared between both treatment strategies.
Patients receiving intensive treatment were younger and more often ACPA-positive. On a group level, there was no significant association between intensive treatment and DMARD-free remission (35% vs 29%, corrected hazard ratio (HR) 1.4, 95%CI 0.9-2.2), nor in ACPA-negative RA (49% versus 44%). In ACPA-positive RA intensive treatment resulted in more DMARD-free remission (25% vs 6%, corrected HR 4.9, 95%CI 1.4-17). Intensive treatment was associated with more late flares (20% versus 8%, HR 2.3, 95%CI 0.6-8.3). Subsequently, there was no difference in DMARD-free sustained remission on a group level (28% versus 27%), nor in the ACPA-negative (43% versus 42%) or ACPA-positive stratum (17% versus 6%, corrected HR 3.1, 95%CI 0.9-11).
Intensive treatment did not result in more DMARD-free sustained remission, compared to routine up-to-date care. The data showed a tendency towards an effect of intensive treatment in ACPA-positive RA; this needs further investigation.</description><identifier>ISSN: 1478-6362</identifier><identifier>ISSN: 1478-6354</identifier><identifier>EISSN: 1478-6362</identifier><identifier>DOI: 10.1186/s13075-019-1893-z</identifier><identifier>PMID: 31064384</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Adalimumab ; Adult ; Aged ; Antiarthritic agents ; Antirheumatic agents ; Antirheumatic Agents - therapeutic use ; Arthritis ; Arthritis, Rheumatoid - drug therapy ; Clinical trials ; DMARDs ; Drug dosages ; Drug therapy ; Drug Therapy, Combination - methods ; Epidemiology ; Female ; Glucocorticoids ; Humans ; Male ; Methotrexate ; Methotrexate - therapeutic use ; Middle Aged ; Observational studies ; Outcome measures ; Patient outcomes ; Patients ; Prednisone ; Prednisone - therapeutic use ; Regression (Disease) ; Remission (Medicine) ; Remission Induction ; Rheumatoid arthritis ; Rheumatoid factor ; Rheumatology ; Severity of Illness Index ; Steroids (Organic compounds) ; Study design ; Synovitis ; Systematic review</subject><ispartof>Arthritis research & therapy, 2019-05, Vol.21 (1), p.115-10, Article 115</ispartof><rights>COPYRIGHT 2019 BioMed Central Ltd.</rights><rights>2019. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s). 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c560t-2c315094b9225d866d0c90112339bd797d837641b9f5bb3d9bf421a4b35bcf8b3</citedby><cites>FETCH-LOGICAL-c560t-2c315094b9225d866d0c90112339bd797d837641b9f5bb3d9bf421a4b35bcf8b3</cites><orcidid>0000-0003-1885-2693</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6505077/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2226988932?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,44590,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31064384$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Burgers, L E</creatorcontrib><creatorcontrib>van der Pol, J A</creatorcontrib><creatorcontrib>Huizinga, T W J</creatorcontrib><creatorcontrib>Allaart, C F</creatorcontrib><creatorcontrib>van der Helm-van Mil, A H M</creatorcontrib><title>Does treatment strategy influence the ability to achieve and sustain DMARD-free remission in patients with RA? Results of an observational study comparing an intensified DAS-steered treatment strategy with treat to target in routine care</title><title>Arthritis research & therapy</title><addtitle>Arthritis Res Ther</addtitle><description>To study the impact of treatment strategy on achieving and sustaining disease-modifying antirheumatic drug (DMARD)-free remission in patients with rheumatoid arthritis (RA).
Two hundred seventy-nine RA patients (median follow-up 7.8 years) were studied. Of these, 155 patients participated in a disease activity score (DAS) < 1.6 steered trial aimed at DMARD-free remission. Initial treatment comprised methotrexate with high-dose prednisone (60 mg/day) and a possibility to start biologicals after 4 months. In the same period and hospital, 124 patients were treated according to routine care, comprising DAS < 2.4 steered treatment. Percentages of DMARD-free remission (absence of synovitis for ≥ 1 year after DMARD cessation), late flares (recurrence of clinical synovitis ≥ 1 year after DMARD cessation), and DMARD-free sustained remission (DMARD-free remission sustained during complete follow-up) were compared between both treatment strategies.
Patients receiving intensive treatment were younger and more often ACPA-positive. On a group level, there was no significant association between intensive treatment and DMARD-free remission (35% vs 29%, corrected hazard ratio (HR) 1.4, 95%CI 0.9-2.2), nor in ACPA-negative RA (49% versus 44%). In ACPA-positive RA intensive treatment resulted in more DMARD-free remission (25% vs 6%, corrected HR 4.9, 95%CI 1.4-17). Intensive treatment was associated with more late flares (20% versus 8%, HR 2.3, 95%CI 0.6-8.3). Subsequently, there was no difference in DMARD-free sustained remission on a group level (28% versus 27%), nor in the ACPA-negative (43% versus 42%) or ACPA-positive stratum (17% versus 6%, corrected HR 3.1, 95%CI 0.9-11).
Intensive treatment did not result in more DMARD-free sustained remission, compared to routine up-to-date care. The data showed a tendency towards an effect of intensive treatment in ACPA-positive RA; this needs further investigation.</description><subject>Adalimumab</subject><subject>Adult</subject><subject>Aged</subject><subject>Antiarthritic agents</subject><subject>Antirheumatic agents</subject><subject>Antirheumatic Agents - therapeutic use</subject><subject>Arthritis</subject><subject>Arthritis, Rheumatoid - drug therapy</subject><subject>Clinical trials</subject><subject>DMARDs</subject><subject>Drug dosages</subject><subject>Drug therapy</subject><subject>Drug Therapy, Combination - methods</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Glucocorticoids</subject><subject>Humans</subject><subject>Male</subject><subject>Methotrexate</subject><subject>Methotrexate - therapeutic use</subject><subject>Middle Aged</subject><subject>Observational studies</subject><subject>Outcome measures</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Prednisone</subject><subject>Prednisone - therapeutic use</subject><subject>Regression (Disease)</subject><subject>Remission (Medicine)</subject><subject>Remission Induction</subject><subject>Rheumatoid arthritis</subject><subject>Rheumatoid factor</subject><subject>Rheumatology</subject><subject>Severity of Illness Index</subject><subject>Steroids (Organic compounds)</subject><subject>Study design</subject><subject>Synovitis</subject><subject>Systematic review</subject><issn>1478-6362</issn><issn>1478-6354</issn><issn>1478-6362</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNptkstuEzEUhkcIREvhAdggS6yn-DYz9gYUNVwqFSEVWFu-nEkcTcbB9gSl78w74DSlNFLlxVj__Ofzsc9fVa8JPidEtO8SYbhrakxkTYRk9c2T6pTwTtQta-nTB_uT6kVKK4wplZQ_r04YwS1ngp9Wf-YBEsoRdF7DmFHKUWdY7JAf-2GC0QLKS0Da-MHnHcoBabv0sC3S6FCaUtZ-RPOvs-t53UcAFGHtU_JhLAS00dkXakK_fV6i69kHdA1pGooQ-gJAwSSI22IKox7K2ZPbIRvWGx39uNgb_JhhTL734NB89r1OGSCW_SMN3x5xq--7zDouIO97iGHKfgRkdYSX1bNeDwle3X3Pqp-fPv64-FJffft8eTG7qm3T4lxTy0iDJTeS0saJtnXYSkwIZUwa18nOCda1nBjZN8YwJ03PKdHcsMbYXhh2Vl0euC7oldpEv9Zxp4L26lYIcaF0zN4OoJjtJZOCN6LDHDprnGuIs4abphVC08J6f2BtJrMGZ8ulox6OoMd_Rr9Ui7BVbYMb3HUF8PYOEMOvCVJWqzDF8uBJUUpbKUp06H_XQpeuyvRDgdkyS6tmjeBdwynnxXX-iKssV8Zuwwi9L_pRATkU2BhSitDfN06w2odYHUKsSojVPsTqptS8eXjj-4p_qWV_ATrg8lQ</recordid><startdate>20190507</startdate><enddate>20190507</enddate><creator>Burgers, L E</creator><creator>van der Pol, J A</creator><creator>Huizinga, T W J</creator><creator>Allaart, C F</creator><creator>van der Helm-van Mil, A H M</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><general>BMC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-1885-2693</orcidid></search><sort><creationdate>20190507</creationdate><title>Does treatment strategy influence the ability to achieve and sustain DMARD-free remission in patients with RA? Results of an observational study comparing an intensified DAS-steered treatment strategy with treat to target in routine care</title><author>Burgers, L E ; van der Pol, J A ; Huizinga, T W J ; Allaart, C F ; van der Helm-van Mil, A H M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c560t-2c315094b9225d866d0c90112339bd797d837641b9f5bb3d9bf421a4b35bcf8b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adalimumab</topic><topic>Adult</topic><topic>Aged</topic><topic>Antiarthritic agents</topic><topic>Antirheumatic agents</topic><topic>Antirheumatic Agents - therapeutic use</topic><topic>Arthritis</topic><topic>Arthritis, Rheumatoid - drug therapy</topic><topic>Clinical trials</topic><topic>DMARDs</topic><topic>Drug dosages</topic><topic>Drug therapy</topic><topic>Drug Therapy, Combination - methods</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Glucocorticoids</topic><topic>Humans</topic><topic>Male</topic><topic>Methotrexate</topic><topic>Methotrexate - therapeutic use</topic><topic>Middle Aged</topic><topic>Observational studies</topic><topic>Outcome measures</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>Prednisone</topic><topic>Prednisone - therapeutic use</topic><topic>Regression (Disease)</topic><topic>Remission (Medicine)</topic><topic>Remission Induction</topic><topic>Rheumatoid arthritis</topic><topic>Rheumatoid factor</topic><topic>Rheumatology</topic><topic>Severity of Illness Index</topic><topic>Steroids (Organic compounds)</topic><topic>Study design</topic><topic>Synovitis</topic><topic>Systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Burgers, L E</creatorcontrib><creatorcontrib>van der Pol, J A</creatorcontrib><creatorcontrib>Huizinga, T W J</creatorcontrib><creatorcontrib>Allaart, C F</creatorcontrib><creatorcontrib>van der Helm-van Mil, A H M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection (Proquest)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Arthritis research & therapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Burgers, L E</au><au>van der Pol, J A</au><au>Huizinga, T W J</au><au>Allaart, C F</au><au>van der Helm-van Mil, A H M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Does treatment strategy influence the ability to achieve and sustain DMARD-free remission in patients with RA? Results of an observational study comparing an intensified DAS-steered treatment strategy with treat to target in routine care</atitle><jtitle>Arthritis research & therapy</jtitle><addtitle>Arthritis Res Ther</addtitle><date>2019-05-07</date><risdate>2019</risdate><volume>21</volume><issue>1</issue><spage>115</spage><epage>10</epage><pages>115-10</pages><artnum>115</artnum><issn>1478-6362</issn><issn>1478-6354</issn><eissn>1478-6362</eissn><abstract>To study the impact of treatment strategy on achieving and sustaining disease-modifying antirheumatic drug (DMARD)-free remission in patients with rheumatoid arthritis (RA).
Two hundred seventy-nine RA patients (median follow-up 7.8 years) were studied. Of these, 155 patients participated in a disease activity score (DAS) < 1.6 steered trial aimed at DMARD-free remission. Initial treatment comprised methotrexate with high-dose prednisone (60 mg/day) and a possibility to start biologicals after 4 months. In the same period and hospital, 124 patients were treated according to routine care, comprising DAS < 2.4 steered treatment. Percentages of DMARD-free remission (absence of synovitis for ≥ 1 year after DMARD cessation), late flares (recurrence of clinical synovitis ≥ 1 year after DMARD cessation), and DMARD-free sustained remission (DMARD-free remission sustained during complete follow-up) were compared between both treatment strategies.
Patients receiving intensive treatment were younger and more often ACPA-positive. On a group level, there was no significant association between intensive treatment and DMARD-free remission (35% vs 29%, corrected hazard ratio (HR) 1.4, 95%CI 0.9-2.2), nor in ACPA-negative RA (49% versus 44%). In ACPA-positive RA intensive treatment resulted in more DMARD-free remission (25% vs 6%, corrected HR 4.9, 95%CI 1.4-17). Intensive treatment was associated with more late flares (20% versus 8%, HR 2.3, 95%CI 0.6-8.3). Subsequently, there was no difference in DMARD-free sustained remission on a group level (28% versus 27%), nor in the ACPA-negative (43% versus 42%) or ACPA-positive stratum (17% versus 6%, corrected HR 3.1, 95%CI 0.9-11).
Intensive treatment did not result in more DMARD-free sustained remission, compared to routine up-to-date care. The data showed a tendency towards an effect of intensive treatment in ACPA-positive RA; this needs further investigation.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>31064384</pmid><doi>10.1186/s13075-019-1893-z</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-1885-2693</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Publicly Available Content Database; PubMed Central |
| subjects | Adalimumab Adult Aged Antiarthritic agents Antirheumatic agents Antirheumatic Agents - therapeutic use Arthritis Arthritis, Rheumatoid - drug therapy Clinical trials DMARDs Drug dosages Drug therapy Drug Therapy, Combination - methods Epidemiology Female Glucocorticoids Humans Male Methotrexate Methotrexate - therapeutic use Middle Aged Observational studies Outcome measures Patient outcomes Patients Prednisone Prednisone - therapeutic use Regression (Disease) Remission (Medicine) Remission Induction Rheumatoid arthritis Rheumatoid factor Rheumatology Severity of Illness Index Steroids (Organic compounds) Study design Synovitis Systematic review |
| title | Does treatment strategy influence the ability to achieve and sustain DMARD-free remission in patients with RA? Results of an observational study comparing an intensified DAS-steered treatment strategy with treat to target in routine care |
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