The Dual-Target Strategy in Rheumatoid Arthritis: Put Patients First

Leonard H. Calabrese, DO, is professor of medicine at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, holds the R.J. Fasenmyer Chair of Clinical Immunology and the Theodore F. Classen, DO, Chair of Osteopathic Research and Education, and serves as the vice chair of the Department of Rheumatic and Immunologic Diseases at the Cleveland Clinic.

José A.P. da Silva, MD, PhD, is professor of rheumatology at the Faculty of Medicine University of Coimbra, and head of rheumatology at Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. He previously served as president of the European Board of Rheumatology and chair of the EULAR Education Committee.

References

1. Smolen JS, Breedveld FC, Burmester GR, et al. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis. 2015 Jan;75(1):3–15.
2. Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis. 2020 Jun;79(6):685–699.
3. Singh JA, Saag KG, Bridges SL, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care Res (Hoboken). 2016 Jan;68(1):1–25.
4. Stoffer MA, Schoels MM, Smolen JS, et al. Evidence for treating rheumatoid arthritis to target: Results of a systematic literature search update. Ann Rheum Dis. 2016 Jan;75(1):16–22.
5. Smolen JS. Treat to target in rheumatology: A historical account on occasion of the 10th anniversary. Rheum Dis Clin North Am. 2019 Nov;45(4):477–485.
6. Agrawal M, Colombel JF. Treat-to-target in inflammatory bowel diseases, what is the target and how do we treat? Gastrointest Endosc Clin N Am. 2019 Jul;29(3):421–436.
7. Jacobs BM, Giovannoni G, Schmierer K. No evident disease activity—more than a risky ambition? JAMA Neurol. 2018 Jul 1;75(7):781–782.
8. van Vollenhoven R. Treat-to-target in rheumatoid arthritis—are we there yet? Nat Rev Rheumatol. 2019 Mar;15(3):180–186.
9. Felson DT, Smolen JS, Wells G, et al. American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Arthritis Rheum. 2011 Mar;63(3):573–586.
10. Gotzsche PC. Sensitivity of effect variables in rheumatoid arthritis: A meta-analysis of 130 placebo controlled NSAID trials. J Clin Epidemiol. 1990;43(12):1313–1318.
11. Gnanasakthy A, Barrett A, Norcross L, et al. Use of patient and investigator global impression scales: A review of Food and Drug Administration-approved labeling, 2009 to 2019. Value Health. 2021 Jul;24(7):1016–1023.
12. Ferreira RJO, Duarte C, Ndosi M, et al. Suppressing inflammation in rheumatoid arthritis: Does patient global assessment blur the target? A practice-based call for a paradigm change. Arthritis Care Res (Hoboken). 2018 Mar;70(3):369–378.
13. Ferreira RJO, Dougados M, Kirwan JR, et al. Drivers of patient global assessment in patients with rheumatoid arthritis who are close to remission: An analysis of 1588 patients. Rheumatology (Oxford). 2017 Sep 1;56(9):1573–1578.
14. Ferreira RJO, Carvalho PD, Ndosi M, et al. Impact of patient’s global assessment on achieving remission in patients with rheumatoid arthritis: A multinational study using the METEOR database. Arthritis Care Res (Hoboken). 2019 Oct;71(10):1317–1325.
15. Brites L, Rovisco J, Costa F, et al. High patient global assessment scores in patients with rheumatoid arthritis otherwise in remission do not reflect subclinical inflammation. Joint Bone Spine. 2021 Jun 21;88(6):105242.
16. Ferreira RJO, Welsing PMJ, Jacobs JWG, et al. Revisiting the use of remission criteria for rheumatoid arthritis by excluding patient global assessment: An individual meta-analysis of 5792 patients. Ann Rheum Dis. 2020 Oct 6;annrheumdis-2020-217171.
17. Ferreira RJO, Santos E, Gossec L, da Silva JAP. The patient global assessment in RA precludes the majority of patients otherwise in remission to reach this status in clinical practice. Should we continue to ignore this? Semin Arthritis Rheum. 2020 Aug;50(4):583–585.
18. Jacobs JW. The Computer Assisted Management in Early Rheumatoid Arthritis programme tool used in the CAMERA-I and CAMERA-II studies. Clin Exp Rheumatol. 2016 Sep–Oct;34(5 Suppl 101):S69–S72.
19. Ferreira RJO, Ndosi M, de Wit M, et al. Dual target strategy: A proposal to mitigate the risk of overtreatment and enhance patient satisfaction in rheumatoid arthritis. Ann Rheum Dis. 2019 Oct;78(10):e109.
20. Ferreira RJO, Santos EJF, de Wit M, et al. Shared decision-making in people with chronic disease: Integrating the biological, social and lived experiences is a key responsibility of nurses. Musculoskeletal Care. 2020 Mar;18(1):84–91.
21. Gossec L, Paternotte S, Aanerud GJ, et al. Finalisation and validation of the rheumatoid arthritis impact of disease score, a patient-derived composite measure of impact of rheumatoid arthritis: A EULAR initiative. Ann Rheum Dis. 2011 Jun;70(6):935–942.
22. Duarte C, Santos E, da Silva JAP, et al. The Patient Experienced Symptom State (PESS): A patient-reported global outcome measure that may better reflect disease remission status. Rheumatology (Oxford). 2020 Nov 1;59(11):3458–3467.
23. Epstein RM. Attending: Medicine, Mindfulness, and Humanity. New York: Scribner; 2017.
24. Kvrgic Z, Asiedu GB, Crowson CS, et al. ‘Like no one is listening to me’: A qualitative study of patient-provider discordance between global assessments of disease activity in rheumatoid arthritis. Arthritis Care Res (Hoboken). 2018;70(10):1439–1447.

Editor’s note: This article represents the opinions of the authors and not necessarily those of the ACR or the editors.