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ORIGINAL ARTICLE
Year : 2010  |  Volume : 5  |  Issue : 1  |  Page : 3-10

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


1 A&R Clinic for Arthritis and Rheumatism' and ISIC Superspeciality Hospital, Vasant Kunj, New Delhi 110070, India
2 Indian Association for Medical informatics, India

Correspondence Address:
A N Malaviya
A&R Clinic for Arthritis and Rheumatism' and ISIC Superspeciality Hospital, Vasant Kunj, New Delhi 110070
India
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Source of Support: None, Conflict of Interest: None


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Aims & Objectives: The 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 accord- ingly to achieve predetermined outcome target of disease activity. The objective was to assess the results of tar- geted 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 Methods: RA 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. Results: Study included 215 patients; 16% were having low disease activity or were in remission at the first presen- tation. 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. Conclusion: Using 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.


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