Dr. Steve Paget summarized the “treat to target” approach for rheumatoid arthritis (RA) elegantly in a recent article. He laid out ten principles that make sense.
1. The primary target for RA treatment should be clinical remission.
2. Clinical remission is defined as the absence of signs and symptoms of significant inflammation.
3. While remission is the target, low disease activity is an acceptable alternative.
4. Until the treatment target is reached, drug therapy should be adjusted every three months.
5. Measures of disease activity need to be obtained and documented every month for patients with high disease activity and every three months for patients with low disease activity.
6. Validated measures of disease activity should guide treatment decisions.
7. Structural changes and functional impairment shoulkd be considered when making clinical decisions.
8. The treatment target should be maintained indefinitely.
9. The choice of the disease measuring and the level of target should take patient factors, co-morbidities, and drug-related risk into consideration.
10. The patient needs to be informed about the treatment target and how it will be achieved.
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