title: Evidence for treating rheumatoid arthritis to target: results of a systematic literature search update.
abstract: OBJECTIVE
  A systematic literature review (SLR; 2009-2014) to compare a target-oriented approach with routine management in the treatment of rheumatoid arthritis (RA) to allow an update of the treat-to-target recommendations.
  
  
  METHODS
  Two SLRs focused on clinical trials employing a treatment approach targeting a specific clinical outcome were performed. In addition to testing clinical, functional and/or structural changes as endpoints, comorbidities, cardiovascular risk, work productivity and education as well as patient self-assessment were investigated. The searches covered MEDLINE, EMBASE, Cochrane databases and Clinicaltrial.gov for the period between 2009 and 2012 and separately for the period of 2012 to May of 2014.
  
  
  RESULTS
  Of 8442 citations retrieved in the two SLRs, 176 articles underwent full-text review. According to predefined inclusion/exclusion criteria, six articles were included of which five showed superiority of a targeted treatment approach aiming at least at low-disease activity versus routine care; in addition, publications providing supportive evidence were also incorporated that aside from expanding the evidence provided by the above six publications allowed concluding that a target-oriented approach leads to less comorbidities and cardiovascular risk and better work productivity than conventional care.
  
  
  CONCLUSIONS
  The current study expands the evidence that targeting low-disease activity or remission in the management of RA conveys better outcomes than routine care.
authors.affiliation: Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria University of Applied Sciences for Health Professions Upper Austria, Linz, Austria.
authors.forename: Michaela A
authors.initials: MA
authors.lastname: Stoffer
authors.affiliation: Department of Internal Medicine, Centre for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria.
authors.forename: Monika M
authors.initials: MM
authors.lastname: Schoels
authors.affiliation: Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria Department of Internal Medicine, Centre for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria.
authors.forename: Josef S
authors.initials: JS
authors.lastname: Smolen
authors.affiliation: Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
authors.forename: Daniel
authors.initials: D
authors.lastname: Aletaha
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Ferdinand C
authors.initials: FC
authors.lastname: Breedveld
authors.affiliation: Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Free University and Humboldt University Berlin, Berlin, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Burmester
authors.affiliation: Division of Rheumatology, Weill Cornell Medical College, Cornell University, Hospital for Special Surgery, New York, USA.
authors.forename: Vivian
authors.initials: V
authors.lastname: Bykerk
authors.affiliation: Department of Rheumatology, Hôpital Cochin, Paris Descartes University, Assistance Publique-Hôpitaux de Paris; INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.affiliation: Academic Unit of Musculoskeletal Disease, University of Leeds, Leeds, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Emery
authors.affiliation: Rheumatic Disease Unit, University of Montreal, Montreal, Canada.
authors.forename: Boulos
authors.initials: B
authors.lastname: Haraoui
authors.affiliation: Rheumatology Service and Department of Medicine, Hospital Clinico Universitario, Universidad de Santiago, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Gomez-Reino
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
authors.affiliation: Department of Medicine, University of Queensland, Brisbane, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Nash
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands Department of Rheumatology, University Hospital La Paz, Madrid, Spain.
authors.forename: Victoria
authors.initials: V
authors.lastname: Navarro-Compán
authors.affiliation: Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.
authors.forename: Marieke
authors.initials: M
authors.lastname: Scholte-Voshaar
authors.affiliation: The Karolinska Institute, Stockholm, Sweden.
authors.forename: Ronald
authors.initials: R
authors.lastname: van Vollenhoven
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Désirée
authors.identifier: http://orcid.org/0000-0002-5781-158X
authors.initials: D
authors.lastname: van der Heijde
authors.affiliation: Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
authors.forename: Tanja A
authors.initials: TA
authors.lastname: Stamm
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D002986:Clinical Trials as Topic; D015897:Comorbidity; D019317:Evidence-Based Medicine; D006801:Humans; D010347:Patient Care Planning; D011859:Radiography; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents
keywords: Disease Activity; Rheumatoid Arthritis; Treatment