Advertisement

Treating rheumatoid arthritis to target: an international initiative

  • Elana J. BernsteinEmail author
  • Jonathan Kay
  • Allan Gibofsky
INVITED COMMENTARY
  • 78 Downloads

What do the following have in common: low-density lipoprotein (LDL), hemoglobin A1C, and blood pressure? Each is a parameter that is used as a therapeutic target in disease management: LDL for coronary artery disease (CAD), hemoglobin A1C for diabetes, and blood pressure for both diabetes and chronic kidney disease. The approach of “treating to a target” is not a new concept in clinical medicine. Indeed, such a goal-directed therapeutic strategy is already the standard approach in many specialties, and failure to achieve the set target predicts both morbidity and mortality. For example, the goal of reducing LDL is widely accepted and adhered to by both cardiologists and primary care physicians (PCPs), with the target LDL goal determined by the number of CAD risk factors that are present in an individual patient. The Joint National Commission (JNC) 7 blood pressure guidelines are also commonly followed by medical professionals. Physicians have come to recognize that blood pressures...

Keywords

Rheumatoid arthritis Treatment Remission Low disease activity Treating rheumatoid arthritis to target Treat to target 

Notes

Disclosure

E.J. Bernstein: none. A. Gibofsky: consultant to Abbott, Amgen, Pfizer, Roche, UCB, honoraria from Abbott, Amgen, Pfizer, Roche, UCB; payment for development of educational presentations from Abbott, Amgen, Pfizer, Roche, UCB; stock/stock options for Abbott, Amgen, BMS, Johnson & Johnson, Pfizer; Chair of the United States Steering Committee of the International Treat to Target Initiative. J. Kay: consultant to Centocor Ortho Biotech, Array BioPharma, Celgene, Bristol-Myers Squibb, Eisai Research Institute, UCB, Genentech, Roche, Pfizer, Mallinckrodt, Novo Nordisk, Johnson & Johnson, Sanofi-Aventis, Wyeth; member of the United States Steering Committee of the International Treat to Target Initiative.

References

  1. 1.
    Grigor C, Capell H, Stirling A, et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): A single-blind randomised controlled trial. Lancet. 2004;364:263–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Verstappen SM, Jacobs JW, van der Veen MJ, et al. Intensive treatment with methotrexate in early rheumatoid arthritis: aiming for remission. Computer Assisted Management in Early Rheumatoid Arthritis (CAMERA, an open-label strategy trial). Ann Rheum Dis. 2007;66:1443–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Goekoop-Ruiterman YPM, de Vries-Bouwstra JK, Allaart CF, et al. Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study). Arthritis Rheum. 2008;58:S126–35.PubMedCrossRefGoogle Scholar
  4. 4.
    Smolen JS, Aletaha D, Bijlsma JW, et al. Treating rheumatoid arthritis to target: Recommendations of an international task force. Ann Rheum Dis. 2010;69:631–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Schoel's M, Aletaha D, Smolen JS, et al. Follow-up standards and treatment targets in rheumatoid arthritis: Results of a questionnaire at the EULAR 2008. Ann Rheum Dis. 2010;69:575–8.CrossRefGoogle Scholar
  6. 6.
    de Wit MPT, Smolen JS, Gossec L, van der Heijde DMFM. Treating rheumatoid arthritis to target: The patient version of the international recommendations. Ann Rheum Dis. 2011; Epub ahead of print.Google Scholar
  7. 7.
    Pincus T, Yazici Y, Bergman MJ. RAPID3, an index to assess and monitor patients with rheumatoid arthritis, without formal joint counts: Similar results to DAS28 and CDAI in clinical trials and clinical care. Rheum Dis Clin North Am. 2009;35:773–8.PubMedCrossRefGoogle Scholar
  8. 8.
    van Tuyl LH, Lems WF, Voskuyl AE. Tight control and intensified COBRA combination treatment in early rheumatoid arthritis: 90% remission in a pilot trial. Ann Rheum Dis. 2008;67:1574–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Shaw GB. Man and Superman Act I; 1903.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Elana J. Bernstein
    • 1
    Email author
  • Jonathan Kay
    • 2
  • Allan Gibofsky
    • 1
  1. 1.Hospital for Special SurgeryNew YorkUSA
  2. 2.Rheumatology CenterUMass Memorial Medical CenterWorcesterUSA

Personalised recommendations