Treatment Goals and Strategies
Goal of Therapy Treat-to-Target Strategy Goal of Therapy The goal of therapy is to achieve at least LDA, i.e. CDAI ≤10. Remission, or a state of no disease activity, may be defined by a composite disease activity score or by ACR/EULAR remission criteria. [37] While remission is a reasonable goal for patients with early disease, aiming for remission may not be realistic for all RA patients. Treat-
Goal of Therapy
The goal of therapy is to achieve at least LDA, i.e. CDAI ≤10.
Remission, or a state of no disease activity, may be defined by a composite disease activity score or by ACR/EULAR remission criteria.[37] While remission is a reasonable goal for patients with early disease, aiming for remission may not be realistic for all RA patients.
Treat-to-Target Strategy
Patients who achieve LDA/remission have a low risk of damage progression compared with those with moderate or high disease activity states, with better physical function, improved HRQoL, and fewer comorbidities including normalisation of cardiovascular risk factors, particularly when therapy is commenced in early disease.[38,39] A treat-to-target strategy entails:
- Use of a composite disease activity score at each visit
- Escalation or switching of DMARD therapy until the goal of LDA is achieved
- Frequent follow-up every 1 - 3 months during the first 6 - 18 months of treatment or until LDA/remission is achieved.
Clinicians must aim to achieve LDA in all patients as soon as possible – aiming for 50% improvement in disease activity score within 3 months, and LDA at 6 months. Frequent evaluation is needed (every 1 - 3 months) in patients with active disease, with adjustment of therapy until LDA/remission is reached, after which time less frequent assessments (3 - 6-monthly) are acceptable.
Tarr, G., Govind, N., Seboka, M., Gardiner, E., & Hodkinson, B. (2024). South African Rheumatism and Arthritis Association 2024 updated guidelines for the management of rheumatoid arthritis. South African Medical Journal, 114(9), e2598.