What are the guidelines for treating rheumatoid arthritis (RA) to therapeutic target?

Updated: Feb 07, 2020
  • Author: Howard R Smith, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

The following revised guidelines on treating RA to therapeutic target were issued in 2015 by an international task force of rheumatologists, patient representatives, and a rheumatology nurse [7, 8] :

  • The primary target for treatment of RA should be a state of clinical remission.  (Level of evidence: Ib; grade of recommendation: A) which is defined as the absence of signs and symptoms of significant inflammatory disease activity.  (Level of evidence: IIc; grade of recommendation: B)
  • While remission should be a clear target, low-disease activity may be an acceptable alternative therapeutic goal, particularly in long-standing disease.  (Level of evidence: Ib; grade of recommendation: A)
  • The use of validated composite measures of disease activity, which include joint assessments, is needed in routine clinical practice to guide treatment decisions.  (Level of evidence: Ib; grade of recommendation: A)
  • The choice of the (composite) measure of disease activity and the target value should be influenced by comorbidities, patient factors, and drug-related risks.  (Level of evidence: IV; grade of recommendation: D)
  • Measures of disease activity must be obtained and documented regularly—as frequently as monthly for patients with high/moderate disease activity or less frequently (eg, every 6 mo) for patients in sustained low-disease activity or remission.  (Level of evidence: Ib; grade of recommendation: A)
  • Structural changes and functional impairment and comorbidity should be considered when making clinical decisions, in addition to assessing composite measures of disease activity.  (Level of evidence: IV; grade of recommendation: D)
  • Until the desired treatment target is reached, drug therapy should be adjusted at least every 3 mo.  (Level of evidence: Ib;  grade of recommendation: A)
  • The desired treatment target should be maintained throughout the remaining course of the disease.  (Level of evidence: IIc; grade of recommendation: B)
  • The rheumatologist should involve the patient in setting the treatment target and the strategy to reach this target.  (Level of evidence: IV; grade of recommendation: D)

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