Treat to Target in Juvenile Idiopathic Arthritis: Challenges and Opportunities

Abstract

This article reviews current knowledge around the paradigm “treat to target” (T2T) that has emerged as a successful treatment strategy for chronic diseases. While the majority of the current literature in rheumatic diseases has focused on formally designing and implementing interventions in rheumatoid arthritis (RA), we provide evidence that supports the application of a T2T strategy in the treatment of juvenile idiopathic arthritis (JIA). There is strong evidence for use of T2T in RA, and a recent trial demonstrated success of a Learning Collaborative intervention to implement T2T in clinical practice. While there are no existing clinical trials directly comparing T2T to other treatment strategies for JIA, there is indirect evidence that T2T is not inferior to other treatment strategies. Potential challenges in applying T2T to JIA include the heterogeneity between JIA subtypes, the heterogeneity in outcome measures, and the complexity of successfully incorporating shared decision making in clinical practice. However, there are also several potential benefits of implementingT2T in JIA, and a single-center pilot study has shown initial significant improvement in clinical outcomes. A movement towards adoption of a T2T strategy for JIA has commenced. Further study will be needed to determine best practices for implementation, there is indication that the framework of a Learning Health System may facilitate successful adoption.