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).