Treating rheumatoid arthritis to target: recommendations of an international task force.
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.
Smolen
Josef S
JS
Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna,Waehringer Guertel 18-20, Vienna, Austria. josef.smolen@wienkav.at
Aletaha
Daniel
D
Bijlsma
Johannes W J
JW
Breedveld
Ferdinand C
FC
Boumpas
Dimitrios
D
Burmester
Gerd
G
Combe
Bernard
B
Cutolo
Maurizio
M
de Wit
Maarten
M
Dougados
Maxime
M
Emery
Paul
P
Gibofsky
Alan
A
Gomez-Reino
Juan Jesus
JJ
Haraoui
Boulos
B
Kalden
Joachim
J
Keystone
Edward C
EC
Kvien
Tore K
TK
McInnes
Iain
I
Martin-Mola
Emilio
E
Montecucco
Carlomaurizio
C
Schoels
Monika
M
van der Heijde
Désirée
D
van der Heijde
Desirée
D
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
D018501:Antirheumatic Agents