Treat to Target, Remission and Low Disease Activity in the Treatment of Rheumatoid Arthritis
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Rheumatoid Arthritis (Y Yazici, Section Editor)
Treat to Target, Remission and Low Disease Activity in the Treatment of Rheumatoid Arthritis Martin Jan Bergman, MD Address Drexel University of College of Medicine, Suite 201, Ridley Park, 23 W., Chester Pike, PA, 19078, USA Email: [email protected]
* Springer Nature Switzerland AG 2020
This article is part of the Topical Collection on Rheumatoid Arthritis Keywords Treat to target I Remission I Low disease activity I Outcomes
Abstract Purpose of this review 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. Recent findings 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. Summary 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.
Introduction The treatment of rheumatoid arthritis has evolved from a physician-based “Gestalt” to a measurement
and target-driven approach. This article will summarize the important milestones in this evolution
Rheumatoid Arthritis (Y Yazici, Section Editor) and will discuss the different measures available, the appropriate target for treatment, as well as the
strengths and weaknesses of the Treat to Target approach.
Why measure For decades, the evaluation of rheumatoid arthritis (RA) has been based primarily on “Gestalt”, the general feeling that the treating physician was able to discern the level of disease activity, based on his or her clinical experience. [1•] When treatment options were limited to NSAIDs, gold salts, corticosteroids, and, perhaps, methotrexate (MTX), this might have been appropriate. However, with the development of newer agents, such as combination therapies and the biologics, low disease activity (LDA) and remission (REM) became a realistic outcome, and realistic target. [2, 3]. One of the first studies looking into this was the TICORA study [4••], a study in which patients were treated via two paradigms. Done in the pre-biologic era, a target-directed program using a prescribed treatment plan was compared with “standard of care” (SOC) for the tre
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