Treat-to-target: A tailored treatment approach to rheumatoid arthritis

Rheumatology Department, North Middlesex University Hospital.
British journal of nursing (Mark Allen Publishing) 03/2013; 22(6):308-18. DOI: 10.12968/bjon.2013.22.6.308
Source: PubMed


In contrast to articles and books written about rheumatoid arthritis (RA) two or more decades ago that largely focused on 'coping' with the disease, there have been significant developments in the treatment of RA over the past 10 years. Patients can now be diagnosed and treated and expect to live functional lives, with less likelihood of experiencing the associated joint damage and disability. An important goal of RA therapy has shifted to initiate treatment early and aggressively, with frequent assessment and a target to achieve remission as quickly as possible. This 'treat-to-target' concept has been endorsed to maximise long-term health-related quality of life through control of symptoms, prevention of structural damage, normalisation of function and social participation. This article will look at therapies and strategies for the treatment of RA. It will also discuss a treatment algorithm for rheumatoid arthritis tailored to the individual patient's disease activity status.

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    • "Overtime, RA can lead to long-term cartilage and bone destruction, causing immense pain and joint stiffness. It can also cause inflammation in areas other than the joints, such as the lungs or pericardium, resulting in extra-articular manifestations (Palmer & El Miedany 2013). Despite advances in the medical field, the pathophysiology of RA remains poorly understood, its exact trigger unknown, and there is no known cure for RA. "
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    ABSTRACT: To provide an overview of evidence on the experiences and needs of adults living with rheumatoid arthritis (RA). Many research have studied the impact of RA on one's quality of life, but no reviews have examined the overall experiences of patients living with RA. An integrative review was performed to synthesize the experiences and/or needs of adult patients with RA based on articles retrieved from databases of CINAHL, Scopus, PubMed, PsycINFO and Web of Science, and published between January 2003 and March 2014 in English. A total of 38 studies were reviewed. RA has adverse effects on patients' quality of life due to its negative impacts in their physical and psychosocial aspects of health. Patients with RA cope with these impacts using various methods and are frequent users of healthcare services. However, few studies have evaluated patients' further needs in coping or the effectiveness of their coping mechanisms, and patients' experiences with health care. This review provides evidence for healthcare professionals to gain a better understanding of RA patients' experiences and needs. Future studies can explore interventions that will enhance the quality of current healthcare practices and ultimately improve patients' quality of life. Establishing a positive healthcare professional-patient relationship is crucial and healthcare professionals are in a position to provide greater informational and emotional support to patients. Policy makers and healthcare organizations need to look into ways to enhance the healthcare services to better suit RA patients' needs. © 2015 International Council of Nurses.
    International Nursing Review 01/2015; 62(2). DOI:10.1111/inr.12166 · 0.95 Impact Factor
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    ABSTRACT: Integrating the rheumatoid arthritis (RA) treat-to-target concept into standard clinical practice represents a challenge to health professionals. So far, this practice-changing approach has not been widely implemented, in spite of linking its outcome to payment, which was adopted in the best practice tariffs. The recently published revisions in classification criteria and updated recommendations for optimising the use of disease-modifying anti-rheumatic and biologic agents in the treatment of RA paved the way for re-evaluating the standard clinical care models in order to improve patient outcomes, prevent joint damage, and maintain patients' functional ability as well as their quality of life. This article discusses the recent advances in the management of RA and provides a set of recommendations to provide comprehensive guidance for treatment to target with the aim of improving the quality of care for RA patients.
    British journal of nursing (Mark Allen Publishing) 03/2014; 23(6):310-5. DOI:10.12968/bjon.2014.23.6.310