Original and patient version of the treat-to-target (T2T) recommendations for treating rheumatoid arthritis (RA) to target
| Original | Patient version |
|---|---|
| Overarching T2T principles | |
| (A)The treatment of RA must be based on a shared decision between patient and rheumatologist | (A)Decisions regarding the treatment of RA must be made by the patient and rheumatologist together. |
| (B)The primary goal of treating the patient with RA is to maximise long-term health-related quality of life through control of symptoms, prevention of structural damage, normalisation of function and social participation | (B)The most important goal of treatment is to maximise long-term health-related quality of life. This can be achieved through |
| control of disease symptoms like pain, inflammation, stiffness and fatigue; | |
| prevention of damage to joints and bones; | |
| regaining normal function and participation in daily-life activities. | |
| (C)Abrogation of inflammation is the most important way to achieve these goals | (C)The most important way to achieve these goals is to stop joint inflammation |
| (D)Treatment to target by measuring disease activity and adjusting therapy accordingly optimises outcomes in RA | (D)Treatment toward a clear target of disease activity gives the best results in RA. This can be achieved by measuring disease activity and adjusting therapy if the target is not achieved. |
| Recommendations | |
| (1)The primary target for treatment of RA should be a state of clinical remission | (1)The primary target of treatment of RA should be clinical remission |
| (2)Clinical remission is defined as the absence of signs and symptoms of significant inflammatory disease activity | (2)Clinical remission means that significant signs and symptoms of the disease that are caused by inflammation are absent |
| (3)While remission should be a clear target, based on available evidence low disease activity may be an acceptable alternative therapeutic goal, particularly in established, longstanding disease | (3)Although remission should be the target, it is not possible for some patients, in particular for those with long disease duration. Therefore, low disease activity may be an acceptable alternative. |
| (4)Until the desired treatment target is reached, drug therapy should be adjusted at least every 3 months | (4)Until the desired treatment target is reached, drug therapy should be adjusted at least every 3 months |
| (5)Measures of disease activity must be obtained and documented regularly, as frequently as monthly for patients with high/moderate disease activity or less frequently (such as every 3–6 months) for patients in sustained low disease activity or remission | (5)Disease activity must be measured and documented regularly. For patients with high or moderate disease activity this must be done every month. For patients in a sustained low disease activity state or remission, this can be done less frequently (eg, every 3–6 months). |
| (6)The use of validated composite measures of disease activity, which include joint assessments, is needed in routine clinical practice to guide treatment decisions | (6)Combined disease activity measurements which include joint examinations are needed in routine clinical practice to guide treatment decisions |
| (7)Structural changes and functional impairment should be considered when making clinical decisions, in addition to assessing composite measures of disease activity | (7)Besides disease activity treatment decisions in clinical practice should also consider damage to the joints and restrictions in activities of daily living |
| (8)The desired treatment target should be maintained throughout the remaining course of the disease | (8)The desired treatment target should be maintained throughout the remaining course of the disease |
| (9)The choice of the (composite) measure of disease activity and the level of the target value may be influenced by considerations of comorbidities, patient factors and drug related risks | (9)Selecting the appropriate measurement of disease activity and target may be influenced by the individual situation: presence of other diseases, patient related factors or drug-related safety risks |
| (10)The patient has to be appropriately informed about the treatment target and the strategy planned to reach this target under the supervision of the rheumatologist | (10)The patient has to be appropriately informed about the treatment target and the strategy planned to reach this target under the supervision of the rheumatologist |
Italic words are explained in the glossary (see table 2). Bold words are explained in table 3.