title: Treating rheumatoid arthritis to target: recommendations of an international task force.
abstract: BACKGROUND
  Aiming at therapeutic targets has reduced the risk of organ failure in many diseases such as diabetes or hypertension. Such targets have not been defined for rheumatoid arthritis (RA).
  
  
  OBJECTIVE
  /st> To develop recommendations for achieving optimal therapeutic outcomes in RA.
  
  
  METHODS
  A task force of rheumatologists and a patient developed a set of recommendations on the basis of evidence derived from a systematic literature review and expert opinion; these were subsequently discussed, amended and voted upon by >60 experts from various regions of the world in a Delphi-like procedure. Levels of evidence, strength of recommendations and levels of agreement were derived.
  
  
  RESULTS
  The treat-to-target activity resulted in 10 recommendations. The treatment aim was defined as remission with low disease activity being an alternative goal in patients with long-standing disease. Regular follow-up (every 1-3 months during active disease) with appropriate therapeutic adaptation to reach the desired state within 3 to a maximum of 6 months was recommended. Follow-up examinations ought to employ composite measures of disease activity which include joint counts. Additional items provide further details for particular aspects of the disease. Levels of agreement were very high for many of these recommendations (> or =9/10).
  
  
  CONCLUSIONS
  The 10 recommendations are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA based on evidence and expert opinion.
authors.affiliation: Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna,Waehringer Guertel 18-20, Vienna, Austria. josef.smolen@wienkav.at
authors.forename: Josef S
authors.initials: JS
authors.lastname: Smolen
authors.forename: Daniel
authors.initials: D
authors.lastname: Aletaha
authors.forename: Johannes W J
authors.initials: JW
authors.lastname: Bijlsma
authors.forename: Ferdinand C
authors.initials: FC
authors.lastname: Breedveld
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Boumpas
authors.forename: Gerd
authors.initials: G
authors.lastname: Burmester
authors.forename: Bernard
authors.initials: B
authors.lastname: Combe
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cutolo
authors.forename: Maarten
authors.initials: M
authors.lastname: de Wit
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.forename: Paul
authors.initials: P
authors.lastname: Emery
authors.forename: Alan
authors.initials: A
authors.lastname: Gibofsky
authors.forename: Juan Jesus
authors.initials: JJ
authors.lastname: Gomez-Reino
authors.forename: Boulos
authors.initials: B
authors.lastname: Haraoui
authors.forename: Joachim
authors.initials: J
authors.lastname: Kalden
authors.forename: Edward C
authors.initials: EC
authors.lastname: Keystone
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
authors.forename: Iain
authors.initials: I
authors.lastname: McInnes
authors.forename: Emilio
authors.initials: E
authors.lastname: Martin-Mola
authors.forename: Carlomaurizio
authors.initials: C
authors.lastname: Montecucco
authors.forename: Monika
authors.initials: M
authors.lastname: Schoels
authors.forename: Désirée
authors.initials: D
authors.lastname: van der Heijde
authors.forename: Desirée
authors.initials: D
authors.lastname: van der Heijde
mesh_terms: D000465:Algorithms; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D012074:Remission Induction; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents