NEW YORK (Reuters Health)—A number of recent studies support last year’s update of 2010 treat-to-target recommendations for rheumatoid arthritis (RA), according to the international task force that revised them.
Dr. Josef S. Smolen from Medical University of Vienna, Austria, and colleagues updated their 2010 advice based on systematic literature reviews and expert opinion.
They left the overarching principles largely unchanged, and the final set of 10 recommendations continue to emphasize clinical remission—defined as the absence of signs and symptoms of significant inflammatory disease activity—as the primary treatment target.
“The new recommendations of the task force seem similar to the 2010 recommendations, but they are supported with much more scientific evidence,” rheumatologist Dr. Antonio Naranjo Hernandez from Hospital Universitario de Gran Canaria Doctor Negrin in Las Palmas de Gran Canaria, Spain, told Reuters Health by email. He was not involved in the task force.
Slight changes include changing the monitoring for disease activity in patients with low disease activity or remission from “such as every 3-6 months” to “such as every six months” and the re-emphasis in the final recommendation that “the rheumatologist should involve the patient in setting the treatment target and the strategy to reach this target.”
Originally only two recommendations had the highest levels of supportive evidence (1 or 2), while seven do so now, according to the report, online May 12 in the Annals of the Rheumatic Diseases.
And four recommendations in 2010 had levels of agreement below 9 (out of 10), whereas all recommendations in 2014 carry levels of agreement of 9 or higher.
“While recommendations like the ones presented here may be able to summarise the current state of evidence and provide the respective target audience with some guidance, their implementation is difficult to follow,” the task force writes. “Evaluating the implementation of the treat-to-target (T2T) strategy is clearly an additional important research aspect of the future.”
“In summary,” the report concludes, “the updated version of the treat-to-target recommendations have brought this guidance document to a new level regarding evidence and agreement and will hopefully be adopted by the community of rheumatologists, patients and the other stakeholders.”
“Regular assessment of disease activity and shared decision making with the patients” are the recommendations that deserve the greatest emphasis, Dr. Naranjo said.
He said the best way to achieve these goals is to have a dedicated RA clinic with specialized nurses assigned to patients. “The role of imaging in tight control is now being investigated to show us, for example, if a treat-to-target based on ultrasonography would be superior to the clinical indices,” he added.