Treat to Target, Remission and Low Disease Activity in the Treatment of Rheumatoid Arthritis

Abstract

Treat to Target (T2T) and disease activity measurements have changed the way rheumatologists treat patients, particularly those with rheumatoid arthritis. The author will address the history behind the development of T2T as well as some practical aspects around the use of T2T and disease activity measurement. The stated targets for disease activity are remission and low disease activity (LDA). However, given that these are “surrogate” measures, each individual measure may, in fact, be measuring a different level of disease activity. Ultimately, no single measure is better than any other. Despite this, recent work has demonstrated that patients in whom the target can be attained, there are better outcomes. How long to wait before making a change in therapy and how deep to push toward the absolute abrogation of disease remains unclear. Treat to Target is an attainable and acceptable goal for treating patients with rheumatoid arthritis. The deeper the response, the better the outcome, but a low level of disease activity may be acceptable. Treating patients to target will require that patients are evaluated, using a metric, and that changes are made in therapies, based on this metric and sound medical judgement.