Treat to Target (T2T) – The Goal for all RA Patients
Back in the “old days” when it came to diagnosing and treating rheumatoid arthritis, some doctors used to take a wait and see attitude. The sad outcome with this approach is that many patients needlessly ended up with permanently damaged joints. But now most doctors will stress a swift diagnosis using current diagnostic guidelines.
This notion of a treatment target is not new to medicine. Think about applying the concept to diabetes. Your doctor may wish for you to keep your fasting blood glucose level to between 70-130 mg/dl1. If by diet and exercise alone this target cannot be met, then other treatments may be needed.
The ultimate target for treatment in RA is what is called clinical remission. This is defined as one or less than on tender joint, one or less than one swollen joint, low inflammation blood test, and a strong patient self-assessment2. Some researchers argue that clinical remission is actually not a common phenomenon for RA patients due to many hurdles3. The ultimate goal of treat-to-target (T2T) in rheumatology is to get the RA patient as close to remission or with as low as disease level as possible4.
The processes involved in T2T were developed by an international group of rheumatologists5 Both the rheumatologist and the patient should be involved in the decision-making processes. The physician should use accurate measures to track disease activity and there are several validated surveys available. But in addition to using patient surveys and associated blood tests, the physician should gather important information directly from the patient. If disease activity remains high after several months, then the treatment combination should be modified. The idea is to continually monitor and make adjustments in treatments if disease activity remains moderate or high. With such an approach, RA patients may need to continually experiment with various drugs in an effort to find the best combinations.
The T2T approach can ultimately save the patient from long term joint and tissue damage, provide a higher quality of life, and increase social participation. In a recent study conducted in Europe, it was found that treating RA to target not only helped patients with their symptoms, it also yielded substantial long-term cost savings6.
The rheumatology community is beginning to value the benefits of treat to target for RA patients and the concept is being promoted within their professional communities via publications and workshops. And applications in everyday clinical practices have shown success for patients7
There are so many good reasons to treat to target with rheumatoid arthritis. This treatment approach is an aggressive one and requires vigilance on the part of the patient and rheumatologist. If your RA symptoms remain moderate or severe even after being on a treatment regimen, you should speak to your rheumatologist about treating to target. Maybe it’s time to try a new medication combination.
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