TITRATE research trial-RA participants required

NRAS are pleased to support this important trial

TITRATE Trial: To compare intensive management with standard care in patients with Rheumatoid Arthritis (RA) with intermediate disease activity.

Summary: The National Institute for Health Research (NIHR) is funding a pragmatic randomised controlled trial to compare intensive management with standard care in patients with Rheumatoid Arthritis showing intermediate disease activity (DAS 28-ESR 3.2-5.1). The trial takes place in different hospitals across England and is led by Professor David Scott at King’s College London and King’s College NHS Foundation Trust, London.

The trial has two arms to which patients are randomly allocated: (i) standard care and (ii) intensive management. The first aim of the study is to achieve disappearance of signs and symptoms of RA, e.g. pain, fatigue, mobility, measured by DAS28-ESR (less than 2.6) at 12 months. The secondary aims are to: (i) reduce disability, (ii) improve quality of life and (iii) show that intensive management is acceptable to patients. We will also find out the cost-effectiveness of such an approach compared with standard care.

Assessment: Patients will be screened first to see if they are eligible for the trial (based on certain criteria), and further assessments will take place at the beginning of the trial, at 6 and 12 months. These include completion of a variety of questionnaires, blood tests and x-rays of hands and feet.

Intensive Management Intervention will involve monthly reviews in the outpatient clinic where patients’ intensive treatment will be (i) reviewed and medication adjusted by a rheumatologist and (ii) supportive non-drug advice and guidance will be provided by nurses to meet each patient’s individual needs. This approach will include goal setting, skills teaching, e.g. management of pain, fatigue and physical activity, based on a specifically developed study manual. The nurses will have undergone a bespoke training to deliver this additional support.

Duration of treatment: 12 months.

Safety: Patients will be regularly monitored via blood tests.

If you need any further information about the TITRATE trial, or are interested in participating, please visit the TITRATE website (www.titrate.org.uk) for a full list of participating hospitals.

Alternatively, please contact the Trial Manager, Dr Naomi Martin, on 0207 848 5204 or titrate@kcl.ac.uk.

Please note that you will only be able to participate if the hospital where you are receiving your specialist treatment is involved in the trial.to see the list of participating hospitals visit the titrate website or


11 Replies

  • I would have jumped at the chance to be considered, but save for 3 (out of 18) participating hospitals/Trusts all are way south of where I live/attend. Seems the hospitals, if they were invited to partake, think RD doesn't affect anyone in the North West, or is it another case of the lead team think not much exists north of Watford?!

  • Not a single one in the North west. Manchester area. Do we know why? Can they not get Pennine Acute to participate? Feel as though being excluded! x

  • I'm on the titrate trial through Leighton Hospital I Crewe. I think there 4 of us on the trial so it's worth asking your RA tam at your hospital if you can participate.

  • More units are being added all the time, I've just been in contact with the research lead. if you are interested in being part of this trial make contact with them and they can let you know if there is a unit near you participating. titrate.org.uk

  • Thanks Clare. I would be interested so will be in touch with the unit. Thanks for finding this information for me. x

  • Hi

    I would have been interested to take part too, as yesterday my Mtx therapy has been stopped and I am awaiting my Cons go ahead for new therapy to commence - great timing wrong hospital 👎😞


    J x

  • This is fairly early on in the trial so more units may be added to those currently taking part. I would hazard a guess that it is down to resource and capacity to take on such a trial.If the rheumatology unit are not fully staffed it would make running the trial very difficult. I shall give your feedback to the research leads, or you can email them directly at titrate@kcl.ac.uk

  • Thanks for that Clare. The staffing issue may be the problem at my hospital as my Consultant's been on extended leave since the beginning of the year, though at least one locum has been taken on. I have an appointment next month so will question if it's a future possibility & see how the land lies before contacting.

  • Latest but not exhaustive list of participating hospitals see below

    King's College Hospital NHS Foundation Trust

    Lewisham and Greenwich NHS Trust

    Maidstone and Tunbridge Wells NHS Trust

    Portsmouth Hospitals NHS Trust

    Sheffield Teaching Hospitals NHS Foundation Trust

    Croydon Health Services NHS Trust

    Royal Devon & Exeter NHS Foundation Trust

    RNOH NHS Trust

    Guy's & St Thomas' NHS Foundation Trust

    Gateshead Health NHS Foundation Trust

    The Royal Bournemouth & Christchurch NHS Foundation Trust

    Royal Cornwall Hospitals NHS Trust

    Northumbria Healthcare NHS Foundation Trust

    Plymouth Hospitals NHS Trust

    Derby Hospitals NHS Foundation Trust

    South Devon Healthcare NHS Foundation Trust

    West Suffolk NHS Foundation Trust

    University College London Hospitals NHS Foundation Trust

    Great Western Hospitals NHS Foundation Trust

    The Newcastle Upon Tyne Hospitals NHS Foundation Trust

    Ashford and St Peter's NHS Foundation Trust

    Lancashire Care NHS Foundation Trust

    Northampton General Hospital NHS Trust

    South Tees Hospitals NHS Foundation Trust

    St George's University Hospitals NHS Foundation Trust

    Mid Cheshire Hospitals NHS Foundation Trust

    Nottingham University Hospitals NHS Trust

    Wrightington, Wigan and Leigh NHS Foundation Trust

    The Dudley Group Group NHS Foundation Trust

    University Hospitals Coventry and Warwickshire NHS Trust

    East Kent Hospitals University NHS Foundation Trust

  • My hospital's trust not included unfortunately. Thanks for your continued help though.

  • I wish that they would do trials like this in Scotland 😡

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