title: Obstacles to the implementation of the treat-to-target strategy for rheumatoid arthritis in clinical practice in Japan.
abstract: OBJECTIVE
  To clarify the obstacles preventing the implementation of the treat-to-target (T2T) strategy for rheumatoid arthritis (RA) in clinical practice.
  
  
  METHODS
  A total of 301 rheumatologists in Japan completed a questionnaire. In the first section, participants were indirectly questioned on the implementation of basic components of T2T, and in the second section, participants were directly questioned on their level of agreement and application.
  
  
  RESULTS
  Although nearly all participants set treatment targets for the majority of RA patients with moderate to high disease activity, the proportion who set clinical remission as their target was 59%, with only 45% of these using composite measures. The proportion of participants who monitored X-rays and Health Assessment Questionnaires for all their patients was 44% and 14%, respectively. The proportion of participants who did not discuss treatment strategies was 44%, with approximately half of these reasoning that this was due to a proportion of patients having a lack of understanding of the treatment strategy or inability to make decisions. When participants were directly questioned, there was a high level of agreement with the T2T recommendations.
  
  
  CONCLUSIONS
  Although there was a high level of agreement with the T2T recommendations, major obstacles preventing its full implementation still remain.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine , Shinjuku-ku, Tokyo , Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kaneko
authors.forename: Takao
authors.initials: T
authors.lastname: Koike
authors.forename: Hiromi
authors.initials: H
authors.lastname: Oda
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Miyasaka
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Harigai
authors.forename: Hisashi
authors.initials: H
authors.lastname: Yamanaka
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishiguro
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Takeuchi
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D006801:Humans; D007564:Japan; D010818:Practice Patterns, Physicians'; D012074:Remission Induction / Q000379:methods*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents
keywords: Implementation; Obstacle; Rheumatoid arthritis; Treat-to-target