OBJECTIVES: The management of rheumatoid arthritis (RA) aims to achieve remission or low disease activity. A multidisciplinary model involves diagnosis, treatment, and a follow-up with rheumatology, physiatry, psychology, physiotherapy, occupational therapy and nutrition. We describe the costs of a multiapproach model for patients with RA, and compare the adherence to the model with disease activity.

METHODS: We performed a retrospective study in 2018. We reported clinical outcomes according to DAS28. We included patients with severe or moderate disease activity eceiving biological therapy. There are levels of adherence: High: patient attended between 6 and 12 visits at rheum, and fulla attendace to other specialties. Moderate: 3 -5 visits to rheum and attendance to other 3 specialties. Low: 2 or 1 visits to rheum, attendance to less than two consults for other specialties. We calculated costs of medications, and costs of the center of excellence model. We performed a descriptive analysis and a bivariate analysis. Costs are presented in US dollars at the official rate of exchange for December

RESULTS: We included 395 patients, 84% were female, mean age was 56 years ± 11.4. Regarding disease activity at beginning 82% were in moderate disease activity and 18% in severe disease activity. W evaluated adherence 64% of patients were highly adherent to rheumatology consultation, while only 35% were highly adherent to other medical specialties. The cost of our multidisciplinary model was $428.46 USD year, while the mean cost for biological therapy was $ $9,501/year. The relationship between adherence to our model and DAS28 was posittive, OR 1.83 IC95% (1.05-3.21) (P=0.02).

CONCLUSIONS: The implementation of a low-cost multidisciplinary model, contributes to improve clinical outcomes in RA. Thus, it is important to evaluate different approaches for treating RA. Further research is need to evaluate if in conventional DMARDs and our multidisciplinary model is still a predictor of remission.