Treating rheumatoid arthritis to target: Evidence-based recommendations for enhanced disease management

Abstract

The approach to managing rheumatoid arthritis (RA) is still variable. Questions or issues that frequently arise relating to the application of types and sequences of therapeutic agents as well as to the extent and frequencies of follow up examinations, types of assessments and needs for therapeutic adaptations. In light of these occasional ambiguities, recommendations for the management of rheumatoid arthritis have been recently published.1 In addition, an international expert committee elaborated a guideline document adopting a “treat to target” (T2T) approach for RA; in line with the presentation of the T2T strategy, detailed standard procedures were provided to enable its implementation into daily clinical practice by the rheumatology community.2 While the definition of quantifiable treatment targets is new to RA management, stringent therapeutic aims have already been implemented in a number of other chronic diseases: in diabetes care, aiming for an HbA1c below 7.0% is widely recognized to be the task in every counseling visit, since the achievement of this threshold is understood to drive long-term disease outcomes. Similar procedures are used in treating hypertension, hyperlipidemia, and other conditions, as opposed to the avoidance of adverse outcomes in the distant future; an absolute number that displays a level of good disease control, or, if unmet, the need for treatment escalation is well perceived by doctors and patients alike. Presumably, this facilitates shared treatment decision-making, and also encourages patients to be adherent and responsive during their chronic condition.