Skip to main content

Advertisement

SpringerLink
Log in

Treat to Target in Juvenile Idiopathic Arthritis: Challenges and Opportunities

  • Pediatric Rheumatology (M Becker and J Harris, Section Editors)
  • Published:
Current Treatment Options in Rheumatology Aims and scope Submit manuscript

Absract

Purpose of review

This article reviews current knowledge around the paradigm “treat to target” (T2T) that has emerged as a successful treatment strategy for chronic diseases. While the majority of the current literature in rheumatic diseases has focused on formally designing and implementing interventions in rheumatoid arthritis (RA), we provide evidence that supports the application of a T2T strategy in the treatment of juvenile idiopathic arthritis (JIA).

Recent findings

There is strong evidence for use of T2T in RA, and a recent trial demonstrated success of a Learning Collaborative intervention to implement T2T in clinical practice. While there are no existing clinical trials directly comparing T2T to other treatment strategies for JIA, there is indirect evidence that T2T is not inferior to other treatment strategies. Potential challenges in applying T2T to JIA include the heterogeneity between JIA subtypes, the heterogeneity in outcome measures, and the complexity of successfully incorporating shared decision making in clinical practice. However, there are also several potential benefits of implementingT2T in JIA, and a single-center pilot study has shown initial significant improvement in clinical outcomes.

Summary

A movement towards adoption of a T2T strategy for JIA has commenced. Further study will be needed to determine best practices for implementation, there is indication that the framework of a Learning Health System may facilitate successful adoption.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • Guzman J, Oen K, Tucker LB, Huber AM, Shiff N, Boire G, et al. The outcomes of juvenile idiopathic arthritis in children managed with contemporary treatments: results from the ReACCh-Out cohort. Ann Rheum Dis. 2015;74(10):1854–60. https://doi.org/10.1136/annrheumdis-2014-205372. Modern cohort study that demonstrated a majority of patients with JIA who achieve clinical inactive disease have a subsequent flare in disease activity

    Article  CAS  PubMed  Google Scholar 

  2. • Shoop-Worrall SJW, Kearsley-Fleet L, Thomson W, Verstappen SMM, Hyrich KL. How common is remission in juvenile idiopathic arthritis: a systematic review. Semin Arthritis Rheum. 2017;47(3):331–7. https://doi.org/10.1016/j.semarthrit.2017.05.007. Recently published systematic review of 17 cohort studies that revealed a majority of patients with JIA do not sustain clinical remission at 10 years from diagnosis

    Article  PubMed  PubMed Central  Google Scholar 

  3. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977–86. https://doi.org/10.1056/nejm199309303291401.

    Article  Google Scholar 

  4. Effects morbidity of treatment on in hypertension: II. Results in patients with diastolic blood pressure averaging 90 through 114 mm Hg. JAMA. 1970;213(7):1143–52. https://doi.org/10.1001/jama.1970.03170330025003.

  5. Kiltz U, Smolen J, Bardin T, Cohen Solal A, Dalbeth N, Doherty M, et al. Treat-to-target (T2T) recommendations for gout. Ann Rheum Dis. 2017;76(4):632–8. https://doi.org/10.1136/annrheumdis-2016-209467.

    Article  CAS  PubMed  Google Scholar 

  6. Smolen JS, Braun J, Dougados M, Emery P, Fitzgerald O, Helliwell P, et al. Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: recommendations of an international task force. Ann Rheum Dis. 2014;73(1):6–16. https://doi.org/10.1136/annrheumdis-2013-203419.

    Article  PubMed  Google Scholar 

  7. Smolen JS, Schols M, Braun J, Dougados M, FitzGerald O, Gladman DD, et al. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. Ann Rheum Dis. 2017;77(1):3–17. https://doi.org/10.1136/annrheumdis-2017-211734.

    Article  PubMed  PubMed Central  Google Scholar 

  8. van Vollenhoven RF, Mosca M, Bertsias G, Isenberg D, Kuhn A, Lerstrom K, et al. Treat-to-target in systemic lupus erythematosus: recommendations from an international task force. Ann Rheum Dis. 2014;73(6):958–67. https://doi.org/10.1136/annrheumdis-2013-205139.

    Article  PubMed  Google Scholar 

  9. •• Ravelli A, Horneff G, Laxer RM, Lovell D, Wulffraat N, Consolaro A et al. Treating juvenile idiopathic arthritis to target: recommendations of an international task force. Annals of the rheumatic diseases. under review. New consensus-based overarching principles and recommendations for defining treat-to-target in JIA and incorporating into clinical practice.

  10. Grigor C, Capell H, Stirling A, McMahon AD, Lock P, Vallance R, et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. Lancet. 2004;364(9430):263–9. https://doi.org/10.1016/s0140-6736(04)16676-2.

    Article  PubMed  Google Scholar 

  11. Pope JE, Haraoui B, Rampakakis E, Psaradellis E, Thorne C, Sampalis JS, et al. Treating to a target in established active rheumatoid arthritis patients receiving a tumor necrosis factor inhibitor: results from a real-world cluster-randomized adalimumab trial. Arthritis Care Res. 2013;65(9):1401–9. https://doi.org/10.1002/acr.22010.

    Article  CAS  Google Scholar 

  12. Soubrier M, Lukas C, Sibilia J, Fautrel B, Roux F, Gossec L, et al. Disease activity score-driven therapy versus routine care in patients with recent-onset active rheumatoid arthritis: data from the GUEPARD trial and ESPOIR cohort. Ann Rheum Dis. 2011;70(4):611–5. https://doi.org/10.1136/ard.2010.137695.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Castrejon I, Pincus T, Soubrier M, Lin YC, Rat AC, Combe B, et al. GUEPARD treat-to-target strategy is significantly more efficacious than ESPOIR routine care in early rheumatoid arthritis according to patient-reported outcomes and physician global estimate. Rheumatology (Oxford). 2013;52(10):1890–7. https://doi.org/10.1093/rheumatology/ket230.

    Article  Google Scholar 

  14. Katchamart W, Bombardier C. Systematic monitoring of disease activity using an outcome measure improves outcomes in rheumatoid arthritis. J Rheumatol. 2010;37(7):1411–5. https://doi.org/10.3899/jrheum.090980.

    Article  PubMed  Google Scholar 

  15. Aletaha D, Alasti F, Smolen JS. Optimisation of a treat-to-target approach in rheumatoid arthritis: strategies for the 3-month time point. Ann Rheum Dis. 2016;75(8):1479–85. https://doi.org/10.1136/annrheumdis-2015-208324.

    Article  PubMed  Google Scholar 

  16. Radner H, Alasti F, Smolen JS, Aletaha D. Physical function continues to improve when clinical remission is sustained in rheumatoid arthritis patients. Arthritis Res Ther. 2015;17(1):203. https://doi.org/10.1186/s13075-015-0719-x.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Pincus T, Castrejon I. Evidence that the strategy is more important than the agent to treat rheumatoid arthritis. Data from clinical trials of combinations of non-biologic DMARDs, with protocol-driven intensification of therapy for tight control or treat-to-target. Bull Hosp Jt Dis. 2013;71(Suppl 1):S33–40.

    Google Scholar 

  18. Stoffer MA, Schoels MM, Smolen JS, Aletaha D, Breedveld FC, Burmester G, et al. Evidence for treating rheumatoid arthritis to target: results of a systematic literature search update. Ann Rheum Dis. 2016;75(1):16–22. https://doi.org/10.1136/annrheumdis-2015-207526.

    Article  PubMed  Google Scholar 

  19. Markusse IM, Akdemir G, Dirven L, Goekoop-Ruiterman YP, van Groenendael JH, Han KH, et al. Long-term outcomes of patients with recent-onset rheumatoid arthritis after 10 years of tight controlled treatment: a randomized trial. Ann Intern Med. 2016;164(8):523–31. https://doi.org/10.7326/M15-0919.

    Article  PubMed  Google Scholar 

  20. Schipper LG, van Hulst LT, Grol R, van Riel PL, Hulscher ME, Fransen J. Meta-analysis of tight control strategies in rheumatoid arthritis: protocolized treatment has additional value with respect to the clinical outcome. Rheumatology (Oxford). 2010;49(11):2154–64. https://doi.org/10.1093/rheumatology/keq195.

    Article  Google Scholar 

  21. Vermeer M, Kievit W, Kuper HH, Braakman-Jansen LM, Bernelot Moens HJ, Zijlstra TR, et al. Treating to the target of remission in early rheumatoid arthritis is cost-effective: results of the DREAM registry. BMC Musculoskelet Disord. 2013;14(1):350. https://doi.org/10.1186/1471-2474-14-350.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Smolen JS, Aletaha D, Bijlsma JW, Breedveld FC, Boumpas D, Burmester G, et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010;69(4):631–7. https://doi.org/10.1136/ard.2009.123919.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Smolen JS, Breedveld FC, Burmester GR, Bykerk V, Dougados M, Emery P, et al. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis. 2016;75(1):3–15. https://doi.org/10.1136/annrheumdis-2015-207524.

    Article  PubMed  Google Scholar 

  24. Smolen JS, Landewe R, Breedveld FC, Buch M, Burmester G, Dougados M, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis. 2014;73(3):492–509. https://doi.org/10.1136/annrheumdis-2013-204573.

    Article  CAS  PubMed  Google Scholar 

  25. Smolen JS, Landewe R, Bijlsma J, Burmester G, Chatzidionysiou K, Dougados M, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017;76(6):960–77. https://doi.org/10.1136/annrheumdis-2016-210715.

    Article  PubMed  Google Scholar 

  26. Singh JA, Saag KG, Bridges SL Jr, Akl EA, Bannuru RR, Sullivan MC, et al. 2015 American College of Rheumatology Guideline for the treatment of rheumatoid arthritis. Arthritis Care Res. 2016;68(1):1–25. https://doi.org/10.1002/acr.22783.

    Article  Google Scholar 

  27. Harrold LR, Harrington JT, Curtis JR, Furst DE, Bentley MJ, Shan Y, et al. Prescribing practices in a US cohort of rheumatoid arthritis patients before and after publication of the American College of Rheumatology treatment recommendations. Arthritis Rheum. 2012;64(3):630–8. https://doi.org/10.1002/art.33380.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Solomon DH, Lee SB, Zak A, Corrigan C, Agosti J, Bitton A, et al. Implementation of treat-to-target in rheumatoid arthritis through a Learning Collaborative: rationale and design of the TRACTION trial. Semin Arthritis Rheum. 2016;46(1):81–7. https://doi.org/10.1016/j.semarthrit.2016.02.009.

    Article  PubMed  PubMed Central  Google Scholar 

  29. The breakthrough series: IHI’s collaborative model for achieving breakthrough improvement. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2003.

  30. Langley G, Moen R, Nolan K, Nolan T, Norman C, Provost L. The improvement guide: a practical approach to enhancing organizational performance. 2nd ed. San Francisco: Jossey-Bass; 2009.

    Google Scholar 

  31. Yu Z, Lu B, Agosti J, Bitton A, Corrigan C, Fraenkel L, Harrold LR, Losina E, Katz JN, Solomon DH Implementation of treat to target for rheumatoid arthritis in the US: analysis of baseline data from the TRACTION trial. Arthritis Care Res 2017. https://doi.org/10.1002/acr.23343.

  32. •• Solomon DH, Losina E, Lu B, Zak A, Corrigan C, Lee SB, et al. Implementation of treat-to-target in rheumatoid arthritis through a learning collaborative: results of a randomized controlled trial. Arthritis Rheumatol. 2017;69(7):1374–80. https://doi.org/10.1002/art.40111. Initial results of a randomized trial comparing treat-to-target to usual care in rheumatoid arthritis that demonstrated significant effect of a Learning Collaborative intervention

    Article  PubMed  Google Scholar 

  33. Solomon DH, Fraenkel L, Yu Z, Lu B, Bitton A, Zak A, et al. Benefits and sustainability of a learning collaborative for implementation of treat to target in rheumatoid arthritis: results of phase II of a cluster randomized controlled trial [abstract]. Arthritis Rheumatol. 2017;69(suppl 10):1374–80. https://doi.org/10.1002/art.40111.

    Article  PubMed  Google Scholar 

  34. Lovell DJ, Ruperto N, Giannini EH, Martini A. Advances from clinical trials in juvenile idiopathic arthritis. Nat Rev Rheumatol. 2013;9(9):557–63. https://doi.org/10.1038/nrrheum.2013.105.

    Article  PubMed  Google Scholar 

  35. Minden K. Adult outcomes of patients with juvenile idiopathic arthritis. Horm Res. 2009;72(Suppl 1):20–5. https://doi.org/10.1159/000229759.

    Article  CAS  PubMed  Google Scholar 

  36. Beukelman T, Patkar NM, Saag KG, Tolleson-Rinehart S, Cron RQ, DeWitt EM, et al. 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis care & research. 2011;63(4):465–82. https://doi.org/10.1002/acr.20460.

    Article  Google Scholar 

  37. Ringold S, Weiss PF, Beukelman T, Dewitt EM, Ilowite NT, Kimura Y, et al. 2013 update of the 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: recommendations for the medical therapy of children with systemic juvenile idiopathic arthritis and tuberculosis screening among children receiving biologic medications. Arthritis care & research. 2013;65(10):1551–63. https://doi.org/10.1002/acr.22087.

    Article  Google Scholar 

  38. Ringold S, Weiss PF, Colbert RA, DeWitt EM, Lee T, Onel K, et al. Childhood arthritis and rheumatology research alliance consensus treatment plans for new-onset polyarticular juvenile idiopathic arthritis. Arthritis care & research. 2014;66(7):1063–72. https://doi.org/10.1002/acr.22259.

    Article  Google Scholar 

  39. Ringold S, Tomlinson GA, Weiss PF, Schanberg LE, Feldman BM, Riordan ME et al. The childhood arthritis and rheumatology research alliance start time optimization of biologic therapy in polyarticular JIA study: interim report of baseline patient characteristics and treatment choices [abstract]. Arthritis Rheumatol 2017;69(suppl 10).

  40. DeWitt EM, Kimura Y, Beukelman T, Nigrovic PA, Onel K, Prahalad S, et al. Consensus treatment plans for new-onset systemic juvenile idiopathic arthritis. Arthritis Care Res. 2012;64(7):1001–10. https://doi.org/10.1002/acr.21625.

    CAS  Google Scholar 

  41. Kimura Y, DeWitt EM, Beukelman T, Stoll ML, Nigrovic PA, Onel K, et al. Adding canakinumab to the childhood arthritis and rheumatology research alliance consensus treatment plans for systemic juvenile idiopathic arthritis: comment on the article by DeWitt et al. Arthritis Care Res. 2014;66(9):1430–1. https://doi.org/10.1002/acr.22343.

    Article  CAS  Google Scholar 

  42. Kimura Y, Grevich S, Beukelman T, Morgan E, Nigrovic PA, Mieszkalski K, et al. Pilot study comparing the Childhood Arthritis & Rheumatology Research Alliance (CARRA) systemic juvenile idiopathic arthritis consensus treatment plans. Pediatric Rheumatol Online J. 2017;15(1):23. https://doi.org/10.1186/s12969-017-0157-1.

    Article  Google Scholar 

  43. Specialised Commissioning Team NHS England. Clinical commissioning policy statement: biologic therapies for the treatment of juvenile idiopathic arthritis (JIA). 2015. Available from: https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/10/e03pd-bio-therapies-jia-oct15.pdf.

  44. Swart JF, van Dijkhuizen EHP, Wulffraat NM, de Roock S. Clinical Juvenile Arthritis Disease Activity Score proves to be a useful tool in treat-to-target therapy in juvenile idiopathic arthritis. Ann Rheum Dis. 2017:annrheumdis-2017-212104. https://doi.org/10.1136/annrheumdis-2017-212104.

  45. Tynjala P, Vahasalo P, Tarkiainen M, Kroger L, Aalto K, Malin M, et al. Aggressive combination drug therapy in very early polyarticular juvenile idiopathic arthritis (ACUTE-JIA): a multicentre randomised open-label clinical trial. Ann Rheum Dis. 2011;70(9):1605–12. https://doi.org/10.1136/ard.2010.143347.

    Article  CAS  PubMed  Google Scholar 

  46. Wallace CA, Giannini EH, Spalding SJ, Hashkes PJ, O’Neil KM, Zeft AS, Szer IS, Ringold S, Brunner HI, Schanberg LE, Sundel RP, Milojevic D, Punaro MG, Chira P, Gottlieb BS, Higgins GC, Ilowite NT, Kimura Y, Hamilton S, Johnson A, Huang B, Lovell DJ, for the Childhood Arthritis and Rheumatology Research Alliance Trial of early aggressive therapy in polyarticular juvenile idiopathic arthritis. Arthritis Rheum 2012;64(6):2012–2021. https://doi.org/10.1002/art.34343.

  47. Hissink Muller PC, Brinkman DM, Schonenberg D, Koopman-Keemink Y, Brederije IC, Bekkering WP, et al. A comparison of three treatment strategies in recent onset non-systemic juvenile idiopathic arthritis: initial 3-months results of the BeSt for Kids-study. Pediatric Rheumatol Online J. 2017;15(1):11. https://doi.org/10.1186/s12969-017-0138-4.

    Article  CAS  Google Scholar 

  48. Ruperto N, Murray KJ, Gerloni V, Wulffraat N, de Oliveira SK, Falcini F, et al. A randomized trial of parenteral methotrexate comparing an intermediate dose with a higher dose in children with juvenile idiopathic arthritis who failed to respond to standard doses of methotrexate. Arthritis Rheum. 2004;50(7):2191–201. https://doi.org/10.1002/art.20288.

    Article  CAS  PubMed  Google Scholar 

  49. Vastert SJ, de Jager W, Noordman BJ, Holzinger D, Kuis W, Prakken BJ, et al. Effectiveness of first-line treatment with recombinant interleukin-1 receptor antagonist in steroid-naive patients with new-onset systemic juvenile idiopathic arthritis: results of a prospective cohort study. Arthritis Rheumatol. 2014;66(4):1034–43. https://doi.org/10.1002/art.38296.

    Article  CAS  PubMed  Google Scholar 

  50. Nigrovic PA, Mannion M, Prince FH, Zeft A, Rabinovich CE, van Rossum MA, et al. Anakinra as first-line disease-modifying therapy in systemic juvenile idiopathic arthritis: report of forty-six patients from an international multicenter series. Arthritis Rheum. 2011;63(2):545–55. https://doi.org/10.1002/art.30128.

    Article  CAS  PubMed  Google Scholar 

  51. Lipstein EA, Brinkman WB, Fiks AG, Hendrix KS, Kryworuchko J, Miller VA, Prosser la, Ungar WJ, Fox D An emerging field of research: challenges in pediatric decision making. Medi Decis Mak : Int J Soc Med Decis Mak 2015;35(3):403–408. https://doi.org/10.1177/0272989X14546901.

  52. Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31(2):390–2.

    PubMed  Google Scholar 

  53. Eng SW, Duong TT, Rosenberg AM, Morris Q, Yeung RS, Reacch OUT, et al. The biologic basis of clinical heterogeneity in juvenile idiopathic arthritis. Arthritis Rheumatol. 2014;66(12):3463–75. https://doi.org/10.1002/art.38875.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Giannini EH, Ruperto N, Ravelli A, Lovell DJ, Felson DT, Martini A. Preliminary definition of improvement in juvenile arthritis. Arthritis Rheum. 1997;40(7):1202–9. https://doi.org/10.1002/1529-0131(199707)40.AID-ART3>3.0.CO;2-R

    Article  CAS  PubMed  Google Scholar 

  55. Wallace CA, Giannini EH, Huang B, Itert L, Ruperto N, Childhood Arthritis Rheumatology Research A et al. American College of Rheumatology provisional criteria for defining clinical inactive disease in select categories of juvenile idiopathic arthritis. Arthritis Care Res 2011;63(7):929–936. https://doi.org/10.1002/acr.20497.

  56. Consolaro A, Ruperto N, Bazso A, Pistorio A, Magni-Manzoni S, Filocamo G, et al. Development and validation of a composite disease activity score for juvenile idiopathic arthritis. Arthritis Rheum. 2009;61(5):658–66. https://doi.org/10.1002/art.24516.

    Article  PubMed  Google Scholar 

  57. McErlane F, Beresford MW, Baildam EM, Chieng SE, Davidson JE, Foster HE, et al. Validity of a three-variable Juvenile Arthritis Disease Activity Score in children with new-onset juvenile idiopathic arthritis. Ann Rheum Dis. 2013;72(12):1983–8. https://doi.org/10.1136/annrheumdis-2012-202031.

    Article  PubMed  Google Scholar 

  58. • Consolaro A, Negro G, Chiara Gallo M, Bracciolini G, Ferrari C, Schiappapietra B, et al. Defining criteria for disease activity states in nonsystemic juvenile idiopathic arthritis based on a three-variable juvenile arthritis disease activity score. Arthritis Care Res. 2014;66(11):1703–9. https://doi.org/10.1002/acr.22393. Definition and validation of cut-off criteria for disease activity states in JIA using the cJADAS measure

    Article  Google Scholar 

  59. Taylor J, Giannini EH, Lovell DJ, Huang B, Morgan E. Lack of concordance in inter-rater scoring of the provider’s global assessment of children with juvenile idiopathic arthritis with low disease activity. Arthritis Care Res. 2017;70(1):162–6. https://doi.org/10.1002/acr.23203.

    Article  Google Scholar 

  60. Parchman ML, Zeber JE, Palmer RF. Participatory decision making, patient activation, medication adherence, and intermediate clinical outcomes in type 2 diabetes: a STARNet study. Ann Fam Med. 2010;8(5):410–7. https://doi.org/10.1370/afm.1161.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Wilson SR, Strub P, Buist AS, Knowles SB, Lavori PW, Lapidus J, et al. Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. Am J Respir Crit Care Med. 2010;181(6):566–77. https://doi.org/10.1164/rccm.200906-0907OC.

    Article  PubMed  Google Scholar 

  62. Lipstein EA, Brinkman WB, Britto MT. What is known about parents’ treatment decisions? A narrative review of pediatric decision making. Med Decis Mak : Int J Soc Med Decis Mak. 2012;32(2):246–58. https://doi.org/10.1177/0272989X11421528.

    Article  Google Scholar 

  63. Dodds CM, Britto MT, Denson LA, Lovell DJ, Saeed S, Lipstein EA. Physicians’ perceptions of shared decision making in chronic disease and its barriers and facilitators. J Pedia. 2016;171:307–9 e1–2. https://doi.org/10.1016/j.jpeds.2015.12.071.

    Article  Google Scholar 

  64. Lipstein EA, Dodds CM, Britto MT. Real life clinic visits do not match the ideals of shared decision making. J Pediatr. 2014;165(1):178–83 e1. https://doi.org/10.1016/j.jpeds.2014.03.042.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Magnani A, Pistorio A, Magni-Manzoni S, Falcone A, Lombardini G, Bandeira M, et al. Achievement of a state of inactive disease at least once in the first 5 years predicts better outcome of patients with polyarticular juvenile idiopathic arthritis. J Rheumatol. 2009;36(3):628–34. https://doi.org/10.3899/jrheum.080560.

    Article  PubMed  Google Scholar 

  66. Consolaro A, Bracciolini G, Ruperto N, Pistorio A, Magni-Manzoni S, Malattia C, et al. Remission, minimal disease activity, and acceptable symptom state in juvenile idiopathic arthritis: defining criteria based on the juvenile arthritis disease activity score. Arthritis Rheum. 2012;64(7):2366–74. https://doi.org/10.1002/art.34373.

    Article  PubMed  Google Scholar 

  67. • Buckley L, Ware E, Kreher G, Wiater L, Mehta J, Burnham J. Improving outcomes using a treat to target approach and clinical decision support in polyarticular juvenile idiopathic arthritis [abstract]. Arthritis Rheumatol. 2017;69(suppl 10). Results of a pilot study that demonstrated significant improvement in disease activity when treat-to-target and clinical decision support was applied to patients with polyarticular JIA.

  68. Harris JG, Bingham CA, Morgan EM. Improving care delivery and outcomes in pediatric rheumatic diseases. Curr Opin Rheumatol. 2016;28(2):110–6. https://doi.org/10.1097/BOR.0000000000000257.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff. 2001;20(6):64–78. https://doi.org/10.1377/hlthaff.20.6.64.

    Article  CAS  Google Scholar 

  70. Brinkman WB, Lipstein EA, Taylor J, Schoettker PJ, Naylor K, Jones K, et al. Design and implementation of a decision aid for juvenile idiopathic arthritis medication choices. Pedia Rheumatol Online J. 2017;15(1):48. https://doi.org/10.1186/s12969-017-0177-x.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 4010, Cincinnati, OH, 45229, USA

    Emily A. Smitherman MD & Esi M. Morgan MD, MSCE

  2. Clinica Pediatrica - Reumatologia, Istituto Giannina Gaslini, Genoa, Italy

    Alessandro Consolaro MD, PhD

Authors
  1. Emily A. Smitherman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alessandro Consolaro MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Esi M. Morgan MD, MSCE
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Esi M. Morgan MD, MSCE.

Ethics declarations

Conflict of Interest

Dr. Morgan reports personal fees and non-financial support from T2T JIA 2017–WMA Kongress GmbH, outside the submitted work, and serves as Chair of the Steering Committee and has served as PI, or Co-Investigator, on grants to the Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) which is cited in the manuscript.

Dr. Consolaro reports personal fees from T2T JIA 2017–WMA Kongress GmbH, during the conduct of the study.

Dr. Smitherman declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Pediatric Rheumatology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Smitherman, E.A., Consolaro, A. & Morgan, E.M. Treat to Target in Juvenile Idiopathic Arthritis: Challenges and Opportunities. Curr Treat Options in Rheum 4, 29–43 (2018). https://doi.org/10.1007/s40674-018-0090-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40674-018-0090-6

Keywords

Search

Navigation