Treating rheumatoid arthritis to target: an Italian rheumatologists' survey on the acceptance of the treat-to-target recommendations

Clin Exp Rheumatol. 2014 Jul-Aug;32(4):471-6. Epub 2014 Jun 23.


Objectives: An educational programme was conducted in Italy in order to favour the diffusion of the rheumatoid arthritis (RA) treat-to-target (T2T) recommendations among Italian rheumatologists. Our objective was to measure the level of acceptance and applicability of the 10 recommendations to treat RA to a target of remission/low disease activity in the Italian rheumatology community, before and after the educational programme.

Methods: One hundred rheumatologists working throughout Italy were invited to participate in this two-stage web-based survey (S1-2). Three questions concerning agreement with, applicability of and possible barriers to the applicability of each of the ten T2T recommendations were administered before (S1) and after (S2) an educational event on the T2T strategy in RA. The agreement with each of the 10 recommendations was measured by a 10-point Likert scale. The applicability of each recommendation was assessed by a 5-point Likert scale (never, almost never, sometimes, almost always, always). Finally, three possible barriers to each recommendation applicability were identified.

Results: Seventy-one rheumatologists participated in S1 and 61 in S2. Level of agreement was high (mean score: 8.9 in S1, 9.1 in S2), with each recommendation receiving a score ≥7.9. The highest agreement score was achieved by recommendation 7 in both surveys. Recommendation 8 received the lowest overall agreement in both surveys. Concerning applicability, the majority of responses was 'almost always'. Following the educational programme, the mean degree of agreement with the recommendations increased significantly for recommendations 3, 4, 6, and 10.

Conclusions: The level of knowledge of and agreement with the T2T recommendations for RA among Italian rheumatologists is high and increased significantly for some recommendations following a specific educational event, indicating that a deeper knowledge of the T2T strategy may increase agreement and acceptance.

MeSH terms

  • Adult
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / diagnosis
  • Arthritis, Rheumatoid / drug therapy*
  • Attitude of Health Personnel
  • Drug Utilization Review
  • Education, Medical, Continuing*
  • Female
  • Guideline Adherence* / standards
  • Health Care Surveys
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Italy
  • Male
  • Middle Aged
  • Practice Guidelines as Topic* / standards
  • Practice Patterns, Physicians'* / standards
  • Program Evaluation
  • Rheumatology / education*
  • Rheumatology / standards
  • Surveys and Questionnaires


  • Antirheumatic Agents