Review: Treat to Target in Rheumatoid Arthritis: Fact, Fiction, or Hypothesis?

The treatment armamentarium for rheumatoid arthritis (RA) has grown substantially over the last 15 years since the development of targeted biologic and non-biologic disease modifying anti-rheumatic drugs (DMARDs). These drugs have broadened the treatment possibilities and changed how rheumatic disease experts approach the clinical management of RA. The goal of reducing disease activity to very low levels (or remission) is now realistic, and emerging evidence suggests that treating to achieve these targets enhances long term structural and quality of life outcomes.(1–7) Consequently, “treat to target” (TTT) has become an attractive concept in the clinical management of rheumatoid arthritis (RA). TTT is generally defined as a treatment strategy in which the clinician treats the patient aggressively enough to reach and maintain explicitly specified and sequentially measured goals, such as remission or low disease activity. TTT is proactive, has a clear endpoint (the “target”), and can be operationalized as a specific treatment algorithm, simplifying the multitude of complex medication sequences that can be used to treat active RA. The emerging TTT paradigm is supported by findings from many randomized controlled clinical trials in the last decade, not designed as TTT strategy trials, that suggest the benefits of early aggressive treatment approaches.(5, 8, 9)

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