The best rheumatoid arthritis treatment strategies include treat-to-target elements such as communication between doctor and patient, but not all rheumatologists embrace the approach.
Rheumatoid arthritis (RA) is a chronic autoimmune disease that requires a strong patient-physician relationship to treat symptoms early and ultimately slow the disease progression. When looking at rheumatoid arthritis, new research often focuses on optimal treatment plans that suggest that the best management strategy is something called treat-to-target (TTT).
What Is the Target or Goal of Your RA Treatment Plan?
TTT is not a specific set of treatments, but rather a paradigm that involves discussing with patients in an informed way what their target is for treatment.
“We want to involve them in understanding their goals for treatment, functional requirements, and acceptable pain level. Then together, we translate that goal into a disease target: high, moderate, low, and remission, which we can assess using standard tools,” explains Daniel Solomon, MD, MPH, the chief of the section of clinical sciences in the rheumatology division at Brigham and Women’s Hospital and a professor of medicine at Harvard Medical School in Boston.
Measuring Rheumatoid Arthritis Disease Activity at Each Visit, Adjusting Treatment as Needed
Do you know to what extent your disease activity is controlled?
Once a disease target has been set, providers need to make sure they are measuring the disease activity level at each visit. If the person living with RA is not at target, adjustments need to be made in treatment. “This sounds obvious, but patients with moderate disease activity sometimes have no modifications made. This can lead toongoing disease activity, radiographic progression, and loss of function. Until someone is at target, modifications need to continue to be made,” says Dr. Solomon.
Has the Goal of Your Rheumatoid Arthritis Treatment Plan Changed?
People living with rheumatoid arthritis and their doctors need to be explicit about the plans and their targets. If they are happy with where they are, and not at target, they need to be explicit that they are changing the target. In many patients, remission may not be realistic, and low disease activity is acceptable and all that can be achieved.
Do You Understand What Your Doctor Is Trying to Do?
This shared decision-making process requires physicians to educate patients about treatment options, how they measure disease activity, and what the target is. “Once patients get engaged, more than 50 percent will reach target because it is a more transparent way of tracking treatment,” says Solomon.
Recommendations for Treating to Target in Rheumatoid Arthritis
A study published in December 2015 in Annals of the Rheumatic Diseases by an international task force created an update of the recommendations about treat-to-target:
- The treatment of rheumatoid arthritis must be based on a shared decision between patient and rheumatologist.
- The primary goal of treating people with rheumatoid arthritis is to maximize long-term health-related quality of life through control of symptoms, prevention of structural damage, normalization of function and participation in social and work-related activities.
- Abrogation of (ending) inflammation is the most important way to achieve these goals
- Treatment-to-target by measuring disease activity and adjusting therapy accordingly optimizes outcomes in rheumatoid arthritis.
How TTT Can Improve Symptoms: Results in People Living With RA
Vivian Bykerk, MD, an associate professor of medicine in the division of rheumatology at Cornell University’s Weill Cornell Medical College in Ithaca, New York, who was part of the international task force, explains that TTT improves patients’ outcomes because “patients are examined and then treatments are adjusted as needed to control underlying disease that manifests with joint swelling, pain, and stiffness from inflammation. Reducing this also reduces and eliminates as best as possible associated symptoms of fatigue and low mood, improves general feelings of well-being and health, and restores optimal function.”
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