Treating rheumatoid arthritis to target: recommendations of an international task force
- Josef S Smolen1,2,
- Daniel Aletaha1,
- Johannes W J Bijlsma3,
- Ferdinand C Breedveld4,
- Dimitrios Boumpas5,
- Gerd Burmester6,
- Bernard Combe7,
- Maurizio Cutolo8,
- Maarten de Wit9,
- Maxime Dougados10,
- Paul Emery11,
- Alan Gibofsky12,
- Juan Jesus Gomez-Reino13,
- Boulos Haraoui14,
- Joachim Kalden15,
- Edward C Keystone16,
- Tore K Kvien17,
- Iain McInnes18,
- Emilio Martin-Mola19,
- Carlomaurizio Montecucco20,
- Monika Schoels2,
- Desirée van der Heijde4
- for the T2T Expert Committee
- 1 Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
- 2 2nd Department of Medicine, Center for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria
- 3 University Medical Center Utrecht, Department of Rheumatology and Clinical Immunology, Utrecht, The Netherlands
- 4 Leiden University Medical Center, Department of Rheumatology, Leiden, The Netherlands
- 5 Department of Medicine, Faculty of Medicine, University of Crete, Crete, Greece
- 6 Humboldt University, Department of Rheumatology and Clinical Immunology, Charite Hospital, Berlin, Germany
- 7 Service d'Immuno-Rhumatologie, Montpellier University, Lapeyronie Hospital, Montpellier, France
- 8 Research Laboratory and Academic Clinical Unit of Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
- 9 EULAR Standing Committee of People with Arthritis/Rheumatism in Europe, Zurich, Switzerland
- 10 René Descartes University, Cochin Hospital, Department of Rheumatology B, Paris, France
- 11 Academic Unit of Musculoskeletal Disease, University of Leeds, Leeds, UK
- 12 Weill Medical College, Cornell University Hospital for Special Surgery, New York, USA
- 13 Santiago University Clinical Hospital, NEIRID Laboratory, Santiago de Compostela, Spain
- 14 Institut de rhumatologie de Montréal, Montréal, QC, Canada
- 15 Fiebiger Center, Friedrich-Alexander University, Erlangen, Germany
- 16 University of Toronto, Toronto, Canada
- 17 Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- 18 University of Glasgow, Glasgow, UK
- 19 La Paz Hospital, Madrid, Spain
- 20 Department of Rheumatology, University of Pavia, IRCCS Policlinico S Matteo, Pavia, Italy
- Correspondence to Dr Josef S Smolen, Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna,Waehringer Guertel 18-20, A-1090 Vienna, Austria;
- Accepted 12 January 2010
- Published Online First 9 March 2010
Background Aiming at therapeutic targets has reduced the risk of organ failure in many diseases such as diabetes or hypertension. Such targets have not been defined for rheumatoid arthritis (RA).
Objective To develop recommendations for achieving optimal therapeutic outcomes in RA.
Methods A task force of rheumatologists and a patient developed a set of recommendations on the basis of evidence derived from a systematic literature review and expert opinion; these were subsequently discussed, amended and voted upon by >60 experts from various regions of the world in a Delphi-like procedure. Levels of evidence, strength of recommendations and levels of agreement were derived.
Results The treat-to-target activity resulted in 10 recommendations. The treatment aim was defined as remission with low disease activity being an alternative goal in patients with long-standing disease. Regular follow-up (every 1–3 months during active disease) with appropriate therapeutic adaptation to reach the desired state within 3 to a maximum of 6 months was recommended. Follow-up examinations ought to employ composite measures of disease activity which include joint counts. Additional items provide further details for particular aspects of the disease. Levels of agreement were very high for many of these recommendations (≥9/10).
Conclusion The 10 recommendations are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA based on evidence and expert opinion.
Additional members of the T2T Expert Committee Jose Louis Andreu (Spain), Martin Bergman (USA), Harald Burkhardt (Germany), Vivian Bykerk (Canada), Mario Cardiel (Mexico), Filip Codruta (Romania), Hector Corominas (Spain), Alexandros Drosos (Greece), Patrick Durez (Belgium), Hani ElGabalawy (Canada), Cristina Estrach (UK), Bruno Fautrel (France), Gianfranco Ferracioli (Italy), Roy Fleischman (USA), Joao Eurico Fonseca (Portugal), Cem Gabay (Switzerland), Clara Gjesdal (Norway), Laure Gossec (France), Winfried Graninger (Austria), Espen Haavardsholm (Norway), Sesilie Halland (Norway), Pekka Hannonen (Finland), Jamie Henderson (Canada), Jonathan Kay (USA), Wenche Koldingsnes (Norway), Marios Kouloumas (Cyprus), Ieda Maria Laurindo (Brazil), Marjatta Leirisalo-Repo (Finland), Carlomaurizio Montecucco (Italy), Peter Nash (Australia), Mikkel Ostergaard (Denmark), Andrew Ostor (UK), Karel Pavelka (Czech Republic), José Peirera da Silva (Portugal), Kim Horslev Peterson (Denmark), Duncan Porter (UK), Enid Quest (UK), Evangelos Romas (Australia), Marieke Scholte (The Netherlands), Luigi Sinigaglia (Italy), Tuulikki Sokka (Finland), Ewa Stanislawska (Poland), Tsutomu Takeuchi (Japan), Guillermo Tate (Argentina), Athanasios Tzioufas (Greece), Peter Villiger (Switzerland).
Competing interests This work was supported by an unrestricted educational grant from Abbott Immunology. Abbott affiliates were not involved in the programme or any voting. At the end of the voting process, the Expert Committee was asked to vote in an anonymous fashion if they felt they had been influenced by the sponsoring of the event by Abbott. This ballot resulted in an agreement of 8.7/10 that they did not consider that the fact that Abbott was sponsoring this programme created a bias. The handling editor was F Berenbaum.
Provenance and peer review Not commissioned; externally peer reviewed.
This paper is freely available online under the BMJ Journals unlocked scheme, see http://ard.bmj.com/info/unlocked.dtl