What information should a healthcare provider share with a patient regarding the treat-to-target approach for long-term rheumatoid arthritis (RA) treatment?

From the Guidelines

Healthcare providers should inform patients that the treat-to-target approach for rheumatoid arthritis involves setting specific treatment goals, such as remission or low disease activity, and regularly adjusting therapy until these goals are achieved, with the primary target being a state of clinical remission, as defined by the absence of signs and symptoms of significant inflammatory disease activity 1. The treat-to-target approach requires regular monitoring, typically every 1-3 months when disease is active and every 3-6 months when the disease is controlled, using standardized assessment tools like the DAS28, CDAI, or SDAI scores 1.

• Key aspects of the treat-to-target approach include:
  • Setting specific treatment goals, such as remission or low disease activity
  • Regularly adjusting therapy until these goals are achieved
  • Using standardized assessment tools to monitor disease activity
  • Collaborative decision-making between patient and provider
  • Active patient participation through regular appointments, honest symptom reporting, and adherence to medication regimens
• Treatment typically begins with methotrexate as first-line therapy, with other DMARDs or biologics added if needed, and the choice of treatment should be influenced by considerations of comorbidities, patient-related factors, and drug-related risks 1.
• The desired treatment target should be maintained throughout the remaining course of the disease, and patients should be informed about the treatment target and the strategy planned to reach this target under the supervision of the rheumatologist 1.

From the Research

Information to be Shared with the Patient

The healthcare provider should share the following information with the patient regarding the treat-to-target approach for long-term rheumatoid arthritis (RA) treatment:

• A complete blood count with differential, urinalysis, and creatinine levels will be drawn as baseline references 2.
• Initially, the status of a disease-modifying antirheumatic drug (DMARD) therapy will be assessed every 3 months 2.
• Treatment will be modified in 3 months when needed, based on the patient's response to the current treatment regimen 2.
• Once the goal is achieved, reassessment will be implemented every 6 months to ensure that the patient remains in remission or has low disease activity 2.
• The monitoring is not focused solely on remission achievement, but also on maintaining low disease activity and preventing functional deterioration and radiographic damage 2, 3.

Treatment Approach

The treat-to-target approach involves:

• Using a patient-reported outcome measure, such as the Routine Assessment of Patient Index Data 3 (RAPID3), to assess disease activity 3.
• Setting a treatment target, such as low disease activity or remission, and adjusting treatment accordingly 3, 4.
• Involving the patient in shared decision-making to ensure that they are informed and engaged in their treatment plan 3.
• Using a multidisciplinary approach, including rheumatologists and other healthcare professionals, to provide comprehensive care 3.

Goals of Treatment

The goals of the treat-to-target approach include:

• Achieving low disease activity or remission 2, 3.
• Preventing functional deterioration and radiographic damage 2, 4.
• Improving quality of life and reducing symptoms 2, 3.
• Minimizing the risk of long-term complications, such as atherosclerosis and coronary artery disease 5.