Exploring the "T2T" Goal of RA Treatment

In these days of 2025, the “goal” of rheumatoid arthritis treatment is to treat to target.

The following excerpt is from the arthritis.org website:
“Keeping rheumatoid arthritis (RA) under control is more likely to be successful when you and your doctor set goals and monitor your progress toward them, a concept known in medicine as treat to target (T2T)."¹

T2T is a medical strategy that sets remission – defined as the absence of signs and symptoms of significant inflammatory disease activity – or low disease activity as a goal. Specific disease management targets are set. Then disease activity may be measured as frequently as monthly through lab tests and clinical examinations. If the targets are not reached, medications and/or doses are adjusted according to a predefined protocol. The process continues until the goal is achieved.”

Sounds great, doesn’t it? All we need to do is treat to target and we will have no or low symptoms! Yay!

Not So Easy

In my experience, treatment is never as easy as it sounds. As someone who has been told “your case is challenging”, and the blunt delivery, “you know you’re difficult to treat, right?”, I would love to be able to have “low disease activity”, let alone remission.

The fifth medication I tried finally worked. I had remission with occasional flares for four and a half years, until it quit working. What followed was many more medications which didn’t work or caused reactions. I keep a list of all the medications I am allergic to, along with the medications I take, and my surgeries in my wallet and on the computer. Brain fog prevents me from keeping them all straight. I am currently on my eleventh medication, a monthly infusion that keeps my symptoms at a moderate level and allows me to work full-time.

There's Always Fatigue

I still struggle with fatigue after minimal physical effort and sometimes for no discernible reason. I ache all the time and have late afternoon episodes of pain. I did some fun activities this weekend, and now I’m paying for it. I almost couldn’t get out of bed this morning.

As I enter the twelfth year of my journey with rheumatoid arthritis, I wonder why I always seem to have the “strange” medication reactions. I always call the drug company to report my reactions. Almost every time, the pharmacist will state, “we’ve never had anyone report that reaction!”. It is vitally important to report your adverse reactions to the company, as it may help someone else. These companies are required to keep lists of all adverse reactions.

Diagnosis Isn't Always The Beginning

I also ponder the fact that my journey probably started years before my diagnosis in 2013. I remember days in college and nursing school in the 1980’s, when the struggle to get out of bed was difficult. Fibromyalgia was diagnosed in 2005. The day my rheumatologist said, “If it looks like a duck, waddles like a duck, and quacks like a duck, we’re going to treat it like a duck.” In other words, he began treating me for rheumatoid arthritis before we had any laboratory confirmation of disease.

The treating to target approach makes sense and works for many patients. For those of us who are “challenging”, our target may not be remission or low disease activity. Instead, we may settle for lessened disease activity.