{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T00:38:17Z","timestamp":1793147897348,"version":"4.5.0"},"reference-count":19,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2014,1,28]],"date-time":"2014-01-28T00:00:00Z","timestamp":1390867200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arthritis Care &amp;amp; Research"],"published-print":{"date-parts":[[2014,2]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate barriers that prevent rheumatoid arthritis (RA) patients from achieving Disease Activity Score in 28 joints using the erythrocyte sedimentation rate (DAS28\u2010ESR) scores within the current recommended levels for low disease activity (LDA) or clinical remission (DAS28\u2010ESR score &lt;3.2).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using an electronic medical record program, clinical data for RA patients treated in Optimising Patient Outcomes in Australian Rheumatology clinics, with a recorded DAS28\u2010ESR score, were collected at one point in time. The data included demographics, medications, disease measures, and the rheumatologist's opinion of the main barriers preventing improvement to the recommended DAS28 score.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 4,037 patients with a recorded DAS28\u2010ESR score, 304 patients (7.5%) had high disease activity (HDA) and 1,211 patients (30%) had moderate disease activity (MDA). For 584 HDA or MDA patients, the barriers to disease control (BTCs) were recorded by the rheumatologist when there was no adjustment to disease\u2010modifying antirheumatic drug (DMARD) therapy. The recorded BTCs were irreversible joint damage (19.7%), patient\u2010driven preference (14.7%), noninflammatory musculoskeletal pain (9.2%), insufficient time to assess the effect of recently initiated DMARDs (9.2%), safety concerns (7.5%), comorbidities (6.5%), resistant disease (6.3%), and other less common reasons. These patients received DMARDs (97.4%), including biologic agents (34.1%), methotrexate (74.8%), and oral corticosteroids (41.8%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study identified clinical situations in which rheumatologists elected to continue RA patients with MDA or HDA on DMARD therapy without adjustment to achieve clinical remission or an LDA target of a DAS28\u2010ESR score &lt;3.2.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.22108","type":"journal-article","created":{"date-parts":[[2013,8,27]],"date-time":"2013-08-27T16:40:46Z","timestamp":1377621646000},"page":"190-196","source":"Crossref","is-referenced-by-count":63,"title":["Barriers to Optimal Disease Control for Rheumatoid Arthritis Patients With Moderate and High Disease Activity"],"prefix":"10.1002","volume":"66","author":[{"given":"Kathleen","family":"Tymms","sequence":"first","affiliation":[{"name":"Canberra Rheumatology Canberra, ACT Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Zochling","sequence":"additional","affiliation":[{"name":"Menzies Research Institute Tasmania Hobart, Tasmania Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Scott","sequence":"additional","affiliation":[{"name":"Roche Products, Dee Why New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Bird","sequence":"additional","affiliation":[{"name":"Combined Rheumatology Practice Sydney, New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Burnet","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Hospital Adelaide, South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"de Jager","sequence":"additional","affiliation":[{"name":"Olser House, Southport Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hedley","family":"Griffiths","sequence":"additional","affiliation":[{"name":"Barwon Rheumatology Service Geelong, Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dave","family":"Nicholls","sequence":"additional","affiliation":[{"name":"Coast Joint Care, Maroochydore Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynden","family":"Roberts","sequence":"additional","affiliation":[{"name":"The Townsville Hospital, Douglas Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Arnold","sequence":"additional","affiliation":[{"name":"Orthopaedic &amp; Arthritis Specialist Centre Chatswood, New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey","family":"Littlejohn","sequence":"additional","affiliation":[{"name":"Monash Medical Centre Clayton, Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,1,28]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.21641"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.123919"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.126532"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.23794"},{"key":"e_1_2_8_6_1","first-page":"S133","article-title":"Multi\u2010centre, observational study shows high proportion of Australian rheumatoid arthritis patients have inadequate disease control","volume":"62","author":"Littlejohn G","year":"2010","journal-title":"Arthritis Rheum"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.20123"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780380107"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keh297"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.22719"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.20629"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1521-6942(03)00024-X"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.20132"},{"key":"e_1_2_8_14_1","first-page":"1293","article-title":"Sources of discrepancy in patient and physician global assessments of rheumatoid arthritis disease activity","volume":"31","author":"Nicolau G","year":"2004","journal-title":"J Rheumatol"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-129-5-199809010-00011"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.30129"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.berh.2007.02.004"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.080182"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kes078"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.22943"}],"container-title":["Arthritis Care &amp; 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