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Evidence for treating rheumatoid arthritis to target: results of a systematic literature search update
  1. Michaela A Stoffer1,2,
  2. Monika M Schoels3,
  3. Josef S Smolen1,3,
  4. Daniel Aletaha1,
  5. Ferdinand C Breedveld4,
  6. Gerd Burmester5,
  7. Vivian Bykerk6,
  8. Maxime Dougados7,
  9. Paul Emery8,
  10. Boulos Haraoui9,
  11. Juan Gomez-Reino10,
  12. Tore K Kvien11,
  13. Peter Nash12,
  14. Victoria Navarro-Compán4,13,
  15. Marieke Scholte-Voshaar14,
  16. Ronald van Vollenhoven15,
  17. Désirée van der Heijde4,
  18. Tanja A Stamm1
  1. 1Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
  2. 2University of Applied Sciences for Health Professions Upper Austria, Linz, Austria
  3. 3Department of Internal Medicine, Centre for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria
  4. 4Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  5. 5Department of Rheumatology and Clinical Immunology, Charité—University Medicine Berlin, Free University and Humboldt University Berlin, Berlin, Germany
  6. 6Division of Rheumatology, Weill Cornell Medical College, Cornell University, Hospital for Special Surgery, New York, USA
  7. 7Department of Rheumatology, Hôpital Cochin, Paris Descartes University, Assistance Publique—Hôpitaux de Paris; INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
  8. 8Academic Unit of Musculoskeletal Disease, University of Leeds, Leeds, UK
  9. 9Rheumatic Disease Unit, University of Montreal, Montreal, Canada
  10. 10Rheumatology Service and Department of Medicine, Hospital Clinico Universitario, Universidad de Santiago, Spain
  11. 11Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  12. 12Department of Medicine, University of Queensland, Brisbane, Australia
  13. 13Department of Rheumatology, University Hospital La Paz, Madrid, Spain
  14. 14Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
  15. 15The Karolinska Institute, Stockholm, Sweden
  1. Correspondence to Dr Tanja A Stamm, Department of Medicine 3, Division of Rheumatology, Medical University of Vienna, Währinger Gürtel 18-20 A, Vienna 1090, Austria; tanja.stamm{at}


Objective A systematic literature review (SLR; 2009–2014) to compare a target-oriented approach with routine management in the treatment of rheumatoid arthritis (RA) to allow an update of the treat-to-target recommendations.

Methods Two SLRs focused on clinical trials employing a treatment approach targeting a specific clinical outcome were performed. In addition to testing clinical, functional and/or structural changes as endpoints, comorbidities, cardiovascular risk, work productivity and education as well as patient self-assessment were investigated. The searches covered MEDLINE, EMBASE, Cochrane databases and for the period between 2009 and 2012 and separately for the period of 2012 to May of 2014.

Results Of 8442 citations retrieved in the two SLRs, 176 articles underwent full-text review. According to predefined inclusion/exclusion criteria, six articles were included of which five showed superiority of a targeted treatment approach aiming at least at low-disease activity versus routine care; in addition, publications providing supportive evidence were also incorporated that aside from expanding the evidence provided by the above six publications allowed concluding that a target-oriented approach leads to less comorbidities and cardiovascular risk and better work productivity than conventional care.

Conclusions The current study expands the evidence that targeting low-disease activity or remission in the management of RA conveys better outcomes than routine care.

  • Rheumatoid Arthritis
  • Treatment
  • Disease Activity

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    Josef S Smolen Ferdinand C Breedveld Gerd R Burmester Vivian Bykerk Maxime Dougados Paul Emery Tore K Kvien M Victoria Navarro-Compán Susan Oliver Monika Schoels Marieke Scholte-Voshaar Tanja Stamm Michaela Stoffer Tsutomu Takeuchi Daniel Aletaha Jose Louis Andreu Martin Aringer Martin Bergman Neil Betteridge Hans Bijlsma Harald Burkhardt Mario Cardiel Bernard Combe Patrick Durez Joao Eurico Fonseca Alan Gibofsky Juan J Gomez-Reino Winfried Graninger Pekka Hannonen Boulos Haraoui Marios Kouloumas Robert Landewe Emilio Martin-Mola Peter Nash Mikkel Ostergaard Andrew Östör Pam Richards Tuulikki Sokka-Isler Carter Thorne Athanasios G Tzioufas Ronald van Vollenhoven Martinus de Wit Desirée van der Heijde
  • Correction
    BMJ Publishing Group Ltd and European League Against Rheumatism