Evidence for treating rheumatoid arthritis to target: results of a systematic literature search.
OBJECTIVE
To summarise existing evidence on a target oriented approach for rheumatoid arthritis (RA) treatment.


METHODS
We conducted a systematic literature search including all clinical trials testing clinical, functional, or structural values of a targeted treatment approach. Our search covered Medline, Embase and Cochrane databases until December 2008 and also conference abstracts (2007, 2008).


RESULTS
The primary search yielded 5881 citations; after the selection process, 76 papers underwent detailed review. Of these, only seven strategic clinical trials were extracted: four studies randomised patients to routine or targeted treatment, two compared two different randomised targets and one compared targeted treatment to a historical control group. Five trials dealt with early RA patients. All identified studies showed significantly better clinical outcomes of targeted approaches than routine approaches. Disability was reported in two studies with no difference between groups. Four studies compared radiographic outcomes, two showing significant benefit of the targeted approach.


CONCLUSIONS
Only few studies employed randomised controlled settings to test the value of treatment to a specific target. However, they provided unanimous evidence for benefits of targeted approaches. Nevertheless, more data on radiographic and functional outcomes and on patients with established RA are needed.
Schoels
Monika
M
2nd Department of Internal Medicine, Centre for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria.
Knevel
Rachel
R
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Aletaha
Daniel
D
Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna, Vienna, Austria.
Bijlsma
Johannes W J
JWJ
Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
Breedveld
Ferdinand C
FC
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Boumpas
Dimitrios T
DT
Department of Internal Medicine, University of Crete Medical School, Heraklion, Greece.
Burmester
Gerd
G
Department of Rheumatology and Clinical Immunology, Humboldt University, Charité Hospital, Berlin, Germany.
Combe
Bernard
B
Service d'Immuno-Rhumatologie, Montpellier University, Lapeyronie Hospital, Montpellier, France.
Cutolo
Maurizio
M
Research Laboratory and Academic Clinical Unit of Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy.
Dougados
Maxime
M
Department of Rheumatology B, René Descartes University, Cochin Hospital, Paris, France.
Emery
Paul
P
Academic Unit of Musculoskeletal Disease, University of Leeds, Leeds, UK.
van der Heijde
Desirée
D
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Huizinga
Tom W J
TWJ
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Kalden
Joachim
J
Department of Internal Medicine III, Institute for Clinical Immunology at the Friedrich-Alexander University, Erlangen, Germany.
Keystone
Edward C
EC
Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Toronto, Canada.
Kvien
Tore K
TK
Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
Martin-Mola
Emilio
E
La Paz Hospital, Madrid, Spain.
Montecucco
Carlomaurizio
C
Department of Rheumatology, University of Pavia, IRCCS Policlinico S. Matteo, Pavia, Italy.
de Wit
Maarten
M
EULAR Standing Committee of People with Arthritis/Rheumatism in Europe, Zurich, Switzerland.
Smolen
Josef S
JS
2nd Department of Internal Medicine, Centre for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria.|Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna, Vienna, Austria.
D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000503:physiopathology; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012107:Research Design; D016896:Treatment Outcome
D018501:Antirheumatic Agents