Article

Treating rheumatoid arthritis to target: recommendations of an international task force

Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna,Waehringer Guertel 18-20, Vienna, Austria.
Annals of the rheumatic diseases (Impact Factor: 9.27). 03/2010; 69(4):631-7. DOI: 10.1136/ard.2009.123919
Source: PubMed

ABSTRACT Aiming at therapeutic targets has reduced the risk of organ failure in many diseases such as diabetes or hypertension. Such targets have not been defined for rheumatoid arthritis (RA).
/st> To develop recommendations for achieving optimal therapeutic outcomes in RA.
A task force of rheumatologists and a patient developed a set of recommendations on the basis of evidence derived from a systematic literature review and expert opinion; these were subsequently discussed, amended and voted upon by >60 experts from various regions of the world in a Delphi-like procedure. Levels of evidence, strength of recommendations and levels of agreement were derived.
The treat-to-target activity resulted in 10 recommendations. The treatment aim was defined as remission with low disease activity being an alternative goal in patients with long-standing disease. Regular follow-up (every 1-3 months during active disease) with appropriate therapeutic adaptation to reach the desired state within 3 to a maximum of 6 months was recommended. Follow-up examinations ought to employ composite measures of disease activity which include joint counts. Additional items provide further details for particular aspects of the disease. Levels of agreement were very high for many of these recommendations (> or =9/10).
The 10 recommendations are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA based on evidence and expert opinion.

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Available from: Johannes W J Bijlsma, Jul 13, 2015
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    • "It goes beyond just information-giving and can be defined as an interactive process between patients and health professionals aimed at supporting and enabling patients to manage their life with arthritis and optimising their health and well being (Zangi 2014). The current European League Against Rheumatism (EULAR) 'treat to target' recommendations and National Institute for Health and Care Excellence (NICE) guidelines for RA, emphasise the importance of patient education and shared decision-making between the patient and the health professional (NICE 2009, Smolen et al. 2010). The NICE guidelines (NICE 2009) also acknowledge the contribution of the clinical nurse specialists (CNS) in coordinating patient care and provision of patient education. "
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    • "Although they both have peculiar features such as the presence of specific autoantibodies, in the case of RA, or involvement of skin and nails, in the case of PsA, they show many similarities. Joint distribution, clinical and radiological manifestations may be so identical -especially early at the beginning of diseasethat differentiation reveals impossibile except if hard-to-gain-biopsy specimens showing distinct vascularization patterns are available [1]. Among all forms of arthritides RA has the worst outcome, so that an early identification and treatment is considered imperative [2]. "
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    • "This is particularly important because the therapeutic approach to RA has greatly improved as a result of its earlier diagnosis and treatment [14] [15] and the availability of bio(techno)logical drugs such as anti-TNFí µí»¼ agents [16]. The European League Against Rheumatism (EULAR) recommendations stress the well-timed use of anti-TNF agents in the case of the premature failure of traditional disease modifying antirheumatic drugs (DMARDs) [17]. The Health Assessment Questionnaire (HAQ) is the most widely used index of disability in RA: it is sensitive, effective, reliable, cheap and rapid to administer, reflects the patients' point of view, and correlates well with measures of chronic "
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