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How low to aim in rheumatoid arthritis? Learning from other disciplines
  1. Duncan Porter1,
  2. James Dale2,
  3. Naveed Sattar3
  1. 1Institute of Infection Immunity and Inflammation, University of Glasgow, Glasgow, UK
  2. 2Centre for Rheumatic Diseases, Royal Infirmary, Glasgow, UK
  3. 3Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, UK
  1. Correspondence to Dr Duncan Porter, Institute of Infection Immunity and Inflammation, University of Glasgow, Gartnavel General Hospital, 1053 Great Western Rd, Glasgow G12 0YN, UK; Duncan.porter{at}


Treat-to-target strategies have been widely adopted as the standard of care for the management of patients with rheumatoid arthritis. The concept of ‘tight control’ is prevalent in other disciplines, particularly in diabetes and cardiovascular risk management. In these disciplines, evidence has accumulated that the utility of tight control strategies must be carefully weighed against the disutility that may arise from multiple interventions, particularly in patients at low risk. There is a lively debate in rheumatology circles about whether treatment should be targeted at achieving low disease activity, clinical remission or imaging remission. As rheumatologists we should learn the lessons from other disciplines, and ensure that we expand the evidence base to ensure our recommendations are securely underpinned by robust evidence.

  • Rheumatoid Arthritis
  • Treatment
  • Disease Activity

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