TY  - JOUR
A1  - Smolen, Josef S.
A1  - Breedveld, Ferdinand C.
A1  - Burmester, Gerd-Rüdiger
A1  - Bykerk, Vivian
A1  - Dougados, Maxime
A1  - Emery, Paul
A1  - Kvien, Tore K.
A1  - Navarro-Compán, M. Victoria
A1  - Oliver, Susan
A1  - Schoels, Monika
A1  - Scholte-Voshaar, Marieke
A1  - Stamm, Tanja
A1  - Stoffer, Michaela
A1  - Takeuchi, Tsutomu
A1  - Aletaha, Daniel
A1  - Andreu, Jose Louis
A1  - Aringer, Martin
A1  - Bergman, Martin
A1  - Bijlsma, Hans
A1  - Burkhardt, Harald
A1  - Cardiel-Ríos, Mario Humberto
A1  - Combe, Bernard
A1  - Durez, Patrick
A1  - Fonseca, Joao Eurico
A1  - Gibofsky, Alan
A1  - Gomez-Reino, Juan J.
A1  - Graninger, Winfried
A1  - Hannonen, Pekka
A1  - Haraoui, Boulos
A1  - Kouloumas, Marios
A1  - Landewe, Robert
A1  - Martin-Mola, Emilio
A1  - Nash, Peter
A1  - Ostergaard, Mikkel
A1  - Östör, Andrew
A1  - Richards, Pam
A1  - Sokka-Isler, Tuulikki
A1  - Thorne, Carter
A1  - Tzioufas, Athanasios G.
A1  - Vollenhoven, Ronald van
A1  - Wit, Martinus de
A1  - Heijde, Désirée M. van der
T1  - Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force
T2  - Annals of the rheumatic diseases
N2  - Background Reaching the therapeutic target of remission or low-disease activity has improved outcomes in patients with rheumatoid arthritis (RA) significantly. The treat-to-target recommendations, formulated in 2010, have provided a basis for implementation of a strategic approach towards this therapeutic goal in routine clinical practice, but these recommendations need to be re-evaluated for appropriateness and practicability in the light of new insights.
Objective To update the 2010 treat-to-target recommendations based on systematic literature reviews (SLR) and expert opinion.
Methods A task force of rheumatologists, patients and a nurse specialist assessed the SLR results and evaluated the individual items of the 2010 recommendations accordingly, reformulating many of the items. These were subsequently discussed, amended and voted upon by >40 experts, including 5 patients, from various regions of the world. Levels of evidence, strengths of recommendations and levels of agreement were derived.
Results The update resulted in 4 overarching principles and 10 recommendations. The previous recommendations were partly adapted and their order changed as deemed appropriate in terms of importance in the view of the experts. The SLR had now provided also data for the effectiveness of targeting low-disease activity or remission in established rather than only early disease. The role of comorbidities, including their potential to preclude treatment intensification, was highlighted more strongly than before. The treatment aim was again defined as remission with low-disease activity being an alternative goal especially in patients with long-standing disease. Regular follow-up (every 1–3 months during active disease) with according therapeutic adaptations to reach the desired state was recommended. Follow-up examinations ought to employ composite measures of disease activity that include joint counts. Additional items provide further details for particular aspects of the disease, especially comorbidity and shared decision-making with the patient. Levels of evidence had increased for many items compared with the 2010 recommendations, and levels of agreement were very high for most of the individual recommendations (≥9/10).
Conclusions The 4 overarching principles and 10 recommendations are based on stronger evidence than before and are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA.
KW  - Disease Activity
KW  - Early Rheumatoid Arthritis
KW  - Outcomes research
KW  - Rheumatoid Arthritis
KW  - Treatment
Y1  - 2015
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/40531
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-405319
N1  - This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/ licenses/by-nc/4.0/
VL  - 75
IS  - 1
SP  - 3
EP  - 15
PB  - BMJ Publ. Group
CY  - London
ER  -