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Evidence for treating rheumatoid arthritis to target: results of a systematic literature search
  1. Monika Schoels1,
  2. Rachel Knevel2,
  3. Daniel Aletaha3,
  4. Johannes W J Bijlsma4,
  5. Ferdinand C Breedveld2,
  6. Dimitrios T Boumpas5,
  7. Gerd Burmester6,
  8. Bernard Combe7,
  9. Maurizio Cutolo8,
  10. Maxime Dougados9,
  11. Paul Emery10,
  12. Desirée van der Heijde2,
  13. Tom W J Huizinga2,
  14. Joachim Kalden11,
  15. Edward C Keystone12,
  16. Tore K Kvien13,
  17. Emilio Martin-Mola14,
  18. Carlomaurizio Montecucco15,
  19. Maarten de Wit16,
  20. Josef S Smolen1,3
  1. 12nd Department of Internal Medicine, Centre for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria
  2. 2Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  3. 3Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
  4. 4Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
  5. 5Department of Internal Medicine, University of Crete Medical School, Heraklion, Greece
  6. 6Department of Rheumatology and Clinical Immunology, Humboldt University, Charité Hospital, Berlin, Germany
  7. 7Service d'Immuno-Rhumatologie, Montpellier University, Lapeyronie Hospital, Montpellier, France
  8. 8Research Laboratory and Academic Clinical Unit of Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
  9. 9Department of Rheumatology B, René Descartes University, Cochin Hospital, Paris, France
  10. 10Academic Unit of Musculoskeletal Disease, University of Leeds, Leeds, UK
  11. 11Department of Internal Medicine III, Institute for Clinical Immunology at the Friedrich-Alexander University, Erlangen, Germany
  12. 12 Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Toronto, Canada
  13. 13Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  14. 14La Paz Hospital, Madrid, Spain
  15. 15Department of Rheumatology, University of Pavia, IRCCS Policlinico S. Matteo, Pavia, Italy
  16. 16EULAR Standing Committee of People with Arthritis/Rheumatism in Europe, Zurich, Switzerland
  1. Correspondence to Daniel Aletaha, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Waehringer Guertel 18–20, A-1090 Vienna, Austria; daniel.aletaha{at}


Objectives To summarise existing evidence on a target oriented approach for rheumatoid arthritis (RA) treatment.

Methods We conducted a systematic literature search including all clinical trials testing clinical, functional, or structural values of a targeted treatment approach. Our search covered Medline, Embase and Cochrane databases until December 2008 and also conference abstracts (2007, 2008).

Results The primary search yielded 5881 citations; after the selection process, 76 papers underwent detailed review. Of these, only seven strategic clinical trials were extracted: four studies randomised patients to routine or targeted treatment, two compared two different randomised targets and one compared targeted treatment to a historical control group. Five trials dealt with early RA patients. All identified studies showed significantly better clinical outcomes of targeted approaches than routine approaches. Disability was reported in two studies with no difference between groups. Four studies compared radiographic outcomes, two showing significant benefit of the targeted approach.

Conclusion Only few studies employed randomised controlled settings to test the value of treatment to a specific target. However, they provided unanimous evidence for benefits of targeted approaches. Nevertheless, more data on radiographic and functional outcomes and on patients with established RA are needed.

This paper is freely available online under the BMJ Journals unlocked scheme, see

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  • Web Only Data ard.2009.123976

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  • MS and RK Contributed equally to this study

  • Competing interests This study was supported by an unrestricted educational grant from Abbott Immunology. Abbott had no influence on the selection of papers, extraction of data or writing of this manuscript. Francis Berenbaum was the Handling Editor.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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