Factors associated with the intensification of treatment in XXXX in clinical practice.

@entity1 @entity309
UNASSIGNED: The aim of the present study was to analyse the patterns of treatment adjustment in @entity309 ( @entity309 ) @entity1 with active disease in routine clinical care. This was a cross-sectional study of consecutive @entity1 with @entity309 conducted in five hospitals. Activity scales (DAS28-ESR) and function (HAQ) were measured, as well as whether ultrasound was performed as part of the assessment. Treatment decision (no changes/reduction/intensification) and time to the next scheduled visit were the outcomes variables. Associated factors were analysed by multilevel regression models. A total of 343 @entity1 were included (77  % @entity1 , mean age 57  years, mean @entity309 duration 10  years), of whom 44  % were in remission by DAS28. Treatment was continued in 202 (59  %) @entity1 , reduced in 57 (16  %), and intensified in 83 (24  %). In the 117 @entity1 with active @entity309 (DAS28  >=   3.2), treatment was intensified in 61 (52  %). Factors associated with treatment intensification were physician and @entity1 VAS, and DAS28, but not the centre. In the multilevel regression analysis with intensification of treatment as dependent variable, the following factors were significantly associated: DAS28 [OR 3.67 (95  % CI 2.43-5.52)], @entity1 VAS [OR 1.04 (95  % CI 1.01-1.08)], and have performed an ultrasound [OR 3.36 (95  % CI 1.47-7.68)]. Factors associated with time to the next scheduled visit (an average of 4.3  months) were @entity1 and physician VAS, DAS28, and centre. In clinical practice, half of the @entity1 with active @entity309 maintain or reduce the treatment. The decision to intensify treatment in active @entity309 as recommended by a treat-to-target strategy is complex in practice.
