Despite the use of a goal-directed approach in some inflammatory diseases (e.g., lowering serum uric acid to a target of 6.0 mg/dl in patients with gout), surprisingly, rheumatology as a specialty and rheumatologists in particular appear to be slow in adopting the regular use of standardized, objective metrics in rheumatoid arthritis (RA), let alone a goal-directed approach, linking an objective metric of disease activity to therapeutic intervention. The absence of a “target” does not mean that we have not recognized the need to lower disease activity. But what is the evidence that the philosophy of “the lower the better” holds true for RA disease activity?
Explore This IssueApril 2011
Reviewing the Evidence
In 2008, an international expert panel comprised primarily of rheumatologists began review of available evidence on goal-directed therapy in RA. The results of this effort became the International Treat to Target Initiative, now endorsed by representatives and patients from over 46 countries, and published in 2010.1 This expert panel agreed on several “Overarching Principles” as well as specific recommendations (see Table 1).