The concept of “Treat to Target” (T2T) has become embedded in the modern management of rheumatoid arthritis. Tight control of disease activity in the early stages of disease has been shown to result in improved rates of remission, physical function, and health-related quality of life, and to reduce radiographic progression. But which clinical tool should be used to measure disease activity, and what level of disease activity should be the target? Is it appropriate to aim for clinical remission (defined how?) in all patients? Or should the target be individualised depending on the patient's social, demographic and medical circumstances?
The studies of treatment strategy that underpin current “best practice” will be reviewed, in order to assess the evidence regarding:
1. which measure of disease activity should be utilised
2. what level of disease activity should be targeted
3. how effective T2T strategies are in terms of differing outcomes
4. is it possible or desirable to individualise the treatment target
Rheumatologists learned from other disciplines of medicine, such as diabetology, as they developed T2T strategies of disease management. What more can we learn about the pursuit of tighter targets of disease control, from other disciplines? In particular, it is important to consider any disutility associated with ultra-tight management of disease activity, as well as the benefits. Is there evidence of any disutility associated with ultra-tight management of disease activity that needs to be taken into account? Illustrations from other diseases will be used to stimulate thought about the pros and cons of pursuing ultra-tight disease control.
Disclosure of Interest None declared