OBJECTIVES To describe how it is possible to maintain in remission a cohort of patients in conventional treatment for rheumatoid arthritis (RA), avoiding quickly passing to biological therapy.

METHODS We conducted a descriptive study in patients with RA treated at a Center of Excellence (CoE) for RA in Bogotá-Colombia. Patients were followed-up during 2018 using a treat-to-target strategy with a patient-centered care model. At the CoE, a patient should be evaluated by rheumatologist, physical and occupational therapist, physiatrist, nutritionist and psychologist, at least three times per year. The CoE strategy ensures the adherence of RA patients, guaranteeing opportunity and accessibility to rheumatologists and allied healthcare services. Data were gathered from clinical records; descriptive statistics were estimated and association between clinical and demographic variables was studied by using the Chi-square test. A t-test for paired samples was used to describe the change in DAS28.

RESULTS We analyzed 1265 patients, 82.13% were women. The majority (97.15%) of patients were >40 years-old with average age of 63 years-old (SD: +/-12 years). Most (91.62%) of patients attended six medical appointments during a year, in contrast to the average of three visits per year reported by Colombian Cuenta de Alto Costo; that is why the patients who were in remission remained in the same status, preventing many of them from passing to costly biological therapy. DAS28 slightly decreased from the first appointment (DAS28=2.56) to the sixth one (DAS28=2.45) (p-value=0.0005). Regarding to the prevalence of comorbidities, varied by age groups of 41-50, 51-60, 61-70 and >70 years-old, with 14.29%, 21.84%, 37.73% and 58.24%, respectively [statistically different (p- value <0.0000)].

CONCLUSIONS Patients evidenced a high adherence to the appointments at the CoE. This model is successful, because it allows to keep patients in remission level of disease activity avoiding costly biologicals and impacting positively the budget for the health system.