GE Healthcare Blog - Cardiology, Oncology, Molecular Imaging

Treat to target: Current thinking in RA disease management

According to Mikkel Østergaard, Professor of Rheumatology at the University of Copenhagen and Copenhagen University Hospital at Glostrup, Denmark :

The management of rheumatoid arthritis (RA) has improved dramatically over the last decade due to improved diagnostic and management strategies as well as the introduction of new therapies.

The 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for RA have enabled earlier diagnosis,¹ and clinical trials have documented the clinical and radiographic benefit of early aggressive therapy when aiming for a predefined treatment goal.^2,3 In accordance with this, new management recommendations from EULAR⁴ as well as from an international Treat-to-Target task force,⁵ have set remission as the primary treatment goal for RA in everyday clinical practice.

Now that consensus exists about remission being the appropriate treatment goal for RA, it is crucial to decide on how remission should be defined. Several definitions exist,^6,7 including the recent ACR/EULAR definition of remission in RA for clinical trials.⁸ All current definitions are based on clinical and laboratory parameters. However, modern imaging (magnetic resonance imaging [MRI] and ultrasonography [US]) in patients in clinical remission reveal that a significant number display signs of disease activity such as synovitis and/or osteitis.^9,10

Furthermore, the presence of disease activity detected by imaging techniques is related to subsequent radiographic progression.^11,12 Thus, modern imaging modalities may have an important future role in defining remission in RA.

Learn more from Professor Mikkel Østergaard at Rheumatology congress EULAR 2012, at the GE Healthcare / Abbott co-sponsored symposium: "Treat to target: What are the benefits of using a targeted ultrasound approach?"

Learn more here.

References

1. Aletaha D, et al. Ann Rheum Dis 2010;69:1580–8.

2. Grigor C, et al. Lancet 2004;364:263–9.

3. Hetland ML, et al. Arthritis Rheum 2006;54:1401–9.

4. Smolen JS, et al. Ann Rheum Dis 2010;69:964–75.

5. Smolen JS, et al. Ann Rheum Dis 2010;69:631–7.

6. Pinals RS, et al. Arthritis Rheum 1981;24:1308–15.

7. Prevoo ML, et al. Br J Rheumatol 1996;35:1101–5.

8. Felson DT, et al. Ann Rheum Dis 2011;70:404–13.

9. Brown AK, et al. Arthritis Rheum 2006;54:3761–73.

10. Gandjbakhch F, et al. J Rheumatol 2011;38:2039–44.

11. Brown AK, et al. Arthritis Rheum 2008;58:2958–67.

12. Haavardsholm EA, et al. Ann Rheum Dis 2012; (EULAR 2012 supplement).

Redefining standards of care in Rheumatoid Arthritis with a targeted ultrasound approach

According to Professor Paul Emery, Arthritis Research UK Professor of Rheumatology and Head of the Musculoskeletal Division, Leeds Instituteof Molecular Medicine, University of Leeds, UK : 

In recent years, the introduction of biological agents and application of the Treat to Target (T2T) approach¹  have made clinical remission an achievable goal for many patients with rheumatoid arthritis (RA). Once remission is attained, it is important to maintain absence of disease activity and flare for as long as possible. Available data suggest that up to 50% of patients in clinical remission may experience a disease flare within 2 years² and that increased power Doppler (PD) ultrasound activity in clinical remission is associated with disease flare,³ along with being predictive of longterm structural damage.⁴ 

As such, combining imaging with clinical assessments to monitor RA disease activity may further improve outcomes and help to guide subsequent treatment decisions.

The TURA trial has been designed to assess whether the addition of ultrasound-guided therapy to standard clinical management of RA using T2T principles can further improve outcomes in patients with stable, clinical low disease activity/remission. The primary objective is to determine whether therapy modifications guided by ultrasound findings and DAS28 scores can reduce the level of inflammation assessed by PD ultrasound compared with clinical assessment of DAS28 alone. Other key objectives are to establish whether addition of ultrasound-guided therapy can reduce radiographic progression and improve functional outcomes, and identify predictive factors for sustained remission, absence of structural damage and improvement in functional outcomes. It is hoped that results from the TURA trial will contribute to the development of new and improved disease management principles for RA.

Learn more from Professor Paul Emery at Rheumatology congress EULAR 2012, at the GE Healthcare / Abbott co-sponsored symposium: "Treat to target: What are the benefits of using a targeted ultrasound approach?". Learn more here.

References

1. S molen JS, et al. Ann Rheum Dis 2010;69:631–7.

2. Molenaar ET, et al. Arthritis Rheum 2004;50:36–42.

3. Saleem B, et al. Ann Rheum Dis 2012; 31 Jan [Epub].

4. Brown AK, et al. Arthritis Rheum 2008;58:2958–67.

Treat to target: What are the benefits of using a targeted ultrasound approach?

At EULAR 2012, the Annual European Congress of Rheumatology in Berlin join us at the GE Healthcare / Abbott co-sponsored TUI Satellite Symposium: "Treat to target: What are the benefits of using a targeted ultrasound approach?"

According to the symposium chairman Paul Emery, Arthritis Research UK Professor of Rheumatology, "Treat to Target (T2T) has revolutionised the management of rheumatoid arthritis (RA), making clinical remission a realistic goal for many patients. Imaging modalities are critical for the early diagnosis and monitoring of RA. Application of tools such as sonography in conjunction with T2T principles may further improve clinical outcomes"

Few words about TUI initiative:

Targeted Ultrasound Initiative (TUI) is an international effort led by a world-leading faculty of rheumatologists and ultrasound leads (18 experts from UK, France, Italy, Spain, Germany, Denmark, Japan, Hungary) to help increase the expertise of ultrasonography amongst a network of rheumatologists. TUI also aims to create a network of researchers to undertake multinational research to answer critical questions in the application of ultrasound to clinical practice. http://www.targetedultrasound.net/

Learn more about symposium at EULAR 2012.

Rheumatology...Advancing bone and joint health, helping improve quality of life.

More than 100 million people in Europe are affected by arthritis and/or rheumatism, making it Europe's most widespread chronic disease.¹

Every 30 seconds, a fracture occurs due to osteoporosis.²  Can this be prevented?

A new era of imaging has led to better understanding of bone and joint health. Studies show that early diagnosis and clinical management can help enhance care and contain costs.^3,4

Help enhance care standards and improve quality of life for your patients...

1.PARE Manifesto Steering Group; The PARE Manifesto: A call to Action.

2. Blanchard F, President,Report Working Group. Report on Osteoporosis in the European Community: Building Strong Bones and Preventing Fractures - Action to Prevention. European Communities, Brussels, 1998, EC Report CE-09-97-915-EN-C

3. Fit For Work? (2009) Musculoskeletal Disorders in the European Workforce, Stephen Bevan, Tatiana Quadrello, Robin McGee, Michelle Mahdon, Anna Vavrovsky, Leela Barha

4. V.P.K. Nell, K.P. Machold, G. Eberl, T.A. Stamm, M.Uffmann and J.S. Smolen, Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in Rheumatology, 2004:43:906_914