During the Congress of Clinical Rheumatology Annual Meeting, Dr. Daniel Aletaha, associate professor of medicine at the Medical University of Vienna in Austria, discussed three principals and a list of recommendations for rheumatologists when managing rheumatoid arthritis (RA) patients.
Aletaha, at the gathering of patients, rheumatologists and a nurse specialist, further evaluated a systematic review published in 2010 concerning treat-to-target recommendations for RA.
According to a recent news release, Dr. Aletaha stressed that rheumatologists should (1)set the clinical target before treatment, determining if there is low disease activity or remission; (2) assess care during treatment, deciding when change in therapy is needed; and (3) adjust treatment beyond clinical remission as necessary.
Treat to target (T2T) is an approach to RA treatment that combines aggressive or intensive treatment with disease modifying antirheumatic drugs (DMARDs) with regular monitoring of disease activity. The goal is to achieve a “target” of clinical remission or low disease activity.
Medications should be adjusted at least every 3 months, until the disease target is reached. Measures of disease activity should be obtained monthly for patients with high or moderate RA, and less often for patients with low RA activity or in clinical remission.
When making clinical decisions, doctors should also consider functional impairment, structural changes and other comorbidities (conditions).
According to Dr. Aletaha, clinicians should maintain the treatment target throughout the disease course. The decision about the composite measure of RA disease activity, as well as the target value, should be influenced by patients’ factors, drug-related risks and comorbidities.
“The treat-to-target recommendations provide a basis for implementation of a strategic, routine approach in clinical practice, but will need to re-evaluated for appropriateness and practicability in the light of new insights,” Aletaha said.
In recent years, reaching the therapeutic target of clinical remission or low RA disease activity has improved patients’ clinical outcomes, but understanding the disease pathogenesis and predicting treatment responses remains a major challenges for clinicians.