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.
2nd Department of Internal Medicine, Centre for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria.
Monika
M
Schoels
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Rachel
R
Knevel
Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna, Vienna, Austria.
Daniel
D
Aletaha
Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
Johannes W J
JWJ
Bijlsma
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Ferdinand C
FC
Breedveld
Department of Internal Medicine, University of Crete Medical School, Heraklion, Greece.
Dimitrios T
DT
Boumpas
Department of Rheumatology and Clinical Immunology, Humboldt University, Charité Hospital, Berlin, Germany.
Gerd
G
Burmester
Service d'Immuno-Rhumatologie, Montpellier University, Lapeyronie Hospital, Montpellier, France.
Bernard
B
Combe
Research Laboratory and Academic Clinical Unit of Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy.
Maurizio
M
Cutolo
Department of Rheumatology B, René Descartes University, Cochin Hospital, Paris, France.
Maxime
M
Dougados
Academic Unit of Musculoskeletal Disease, University of Leeds, Leeds, UK.
Paul
P
Emery
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Desirée
D
van der Heijde
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Tom W J
TWJ
Huizinga
Department of Internal Medicine III, Institute for Clinical Immunology at the Friedrich-Alexander University, Erlangen, Germany.
Joachim
J
Kalden
Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Toronto, Canada.
Edward C
EC
Keystone
Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
Tore K
TK
Kvien
La Paz Hospital, Madrid, Spain.
Emilio
E
Martin-Mola
Department of Rheumatology, University of Pavia, IRCCS Policlinico S. Matteo, Pavia, Italy.
Carlomaurizio
C
Montecucco
EULAR Standing Committee of People with Arthritis/Rheumatism in Europe, Zurich, Switzerland.
Maarten
M
de Wit
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.
Josef S
JS
Smolen
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