AB0357 The support of medical clerks in rheumatic disease clinic aids t2t practice for rheumatologists and improves disease activities of patients with rheumatoid arthritis

Background With treat-to-target (T2T), the physician always has to evaluate disease activity and joint damage of rheumatoid arthritis (RA) patients exactly to maintain the activities of daily living of the patient for the long term. However, the amount of work required by physicians to complete T2T can be onerous, so the cooperation of medical staff is necessary to practice T2T. Objectives The purpose of this study is to clarify the role and effectiveness of medical clerks (MCs) in a rheumatic disease clinic. Methods In our rheumatic disease clinic, MCs have supported rheumatologists since April 2011. We individually evaluated 50 RA patients in May 2010 (before MC support: “preceding period”), April 2011 (1 year after the start of MC support: “early period”), April 2013 (3 years after the start of MC support: “middle period”), April 2015 (5 years after the start of MC support: “late period”) and April 2017 (7 years after the start of MC support: “last period”). We assessed the prevalence of T2T practice, disease activity, and drug use. When all components of the Simplified Disease Activity Index (SDAI) of patients had been listed in the medical record and radiography of hand and foot joints had been undertaken more than once a year, the medical examination was defined as “T2T practice”. Disease activity was assessed using the SDAI and Clinical Disease Activity Index (CDAI). Results Prevalence of T2T practice was 50%, 86%, 94%, 100% and 100% at preceding, early, middle, late and last periods, respectively. Prevalence of T2T practice increased after the start of MC support. Accordingly, disease activities improved gradually. SDAI remission was 30.8% in the preceding period, 28.5% in the early period, 30% in the middle period, 58% in the late period and 56% in the last period, respectively. CDAI remission improved towards the last phase, similar to that seen with the SDAI. The mean dose of methotrexate (MTX) increased gradually towards the last phase, but the prevalence of MTX use did not show a remarkable change. Prevalence of use of biological disease-modifying anti-rheumatic drugs did not increase during the study period. Conclusions MC support in rheumatic disease clinics aids T2T practice for rheumatologists. The disease activities of RA patients can be improved by MC support. Disclosure of Interest None declared