Treat-to-target as an approach in inflammatory arthritis

Smolen, Josef S

doi:10.1097/bor.0000000000000284

Cited by 51 publications

(40 citation statements)

References 64 publications

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“…In the field of rheumatology, nurses have an important role in the management of chronic inflammatory arthritis (Vivienne & Michael, ) together with medical doctors and other healthcare professionals. The main treatment goal is to reduce disease activity, prevent structural damage and improve functionality and social participation (Smolen, ). Our results, showing that the participants' health status (perceived pain, tiredness and disease activity) were unchanged, except from a small deterioration in physical function, indicate that the treatment goals probably were almost reached.…”

Section: Discussionmentioning

confidence: 99%

“…The treatment of IA has improved dramatically in later years due to the introduction of biological disease‐modifying anti‐rheumatic drugs (bDMARDs) and early onset of effective treatment (“treat‐to‐target” principle) (Smolen, ). Early diagnosis and treatment are crucial to improve function, radiographic outcomes and prevent work disability (Olofsson et al, ).…”

Section: Introductionmentioning

confidence: 99%

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Health status and self‐management in patients with inflammatory arthritis—A five‐year follow‐up study after nurse‐led patient education

2019

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AimThe aim of this study was to investigate changes in patients' self‐management and health status five years after nurse‐led patient education.DesignA longitudinal study.MethodsWe collected self‐reported data on physical function, pain, tiredness, disease activity, psychological status, patient activation and self‐efficacy from a sample of Norwegian‐speaking adults with inflammatory arthritis that had participated in a randomised controlled study investigating the effects of nurse‐led patient education. Changes and associations in patients' health status and self‐management were analysed with paired sample t tests and multivariable linear regression analyses, respectively.ResultsExcept from a small deterioration in patients' physical function, there were no changes in patients' health status 5 years after the nurse‐led patient education. Patients' self‐management skills were improved after 5 years. Self‐efficacy was positively associated with female gender, patient activation, less tiredness and less psychological distress.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Health status and self‐management in patients with inflammatory arthritis—A five‐year follow‐up study after nurse‐led patient education

2019

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“…Treating to target is an approach to disease management that considers well‐defined physiologic targets for controlling disease activity and the means to achieve them (). This approach has become the standard of care in many chronic diseases, including hypertension, coronary artery disease, diabetes, and rheumatoid arthritis (), and a treat‐to‐target approach has been suggested for gout (). However, the treatment goals for patients with this disease have not been fully defined ().…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Proposed Criteria for Remission and Evidence‐Based Development of Criteria for Complete Response in Patients With Chronic Refractory Gout

Schlesinger

Edwards

Khanna

et al. 2019

ACR Open Rheumatology

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Objective. The objective of this study is to assess criteria for gout remission and to use the results to inform criteria for a complete response (CR).Methods. A post hoc analysis of two clinical trials was undertaken to determine the frequency with which subjects with chronic refractory gout who were treated with pegloticase met remission criteria. Mixed modeling was then employed to identify the components that best correlated with time to maximum benefit.Results. Of the 56 subjects treated with biweekly pegloticase for whom adequate data were collected, 48.2% met the remission criteria. When subjects with persistent lowering of urate levels were examined separately, 27 of 32 (84.4%) met the criteria for remission. In contrast, even when the requirement for lowering of serum urate levels was waived, only 2 of 24 (8.3%) subjects without persistent lowering of urate levels and 0 of 43 subjects receiving placebo met criteria. Mixed modeling indicated that in addition to urate levels, assessment of tophi, swollen joints, and tender joints and patient global assessment best correlated with time to maximum benefit. Using these criteria of CR, 23 of the responders (71.9%) met the criteria. All patients who achieved a CR maintained it for a mean duration of 507.4 days. Finally, 64% of persistent responders to monthly pegloticase also met criteria for CR.Conclusion. These results have validated the proposed remission criteria for gout and have helped define criteria for CR in individuals with chronic gout treated with pegloticase. This composite CR index can serve as an evidence-based target to inform the design and end points of future clinical trials.

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“…As increased disease activity in RA was related with increased FA beliefs, increased work loss and decreased physical activity, intensive treatment with treat to target strategy 29 may increase remission rate and help to combat against FA beliefs. Moreover, an inverse relationship was found between knowledge of pain neurophysiology and the level of FA.…”

Section: Discussionmentioning

confidence: 99%

High Disease Activity May Increase Fear-Avoidance Beliefs in Rheumatoid Arthritis

et al. 2017

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Objectives:This study aims to compare fear-avoidance (FA) beliefs of rheumatoid arthritis (RA) patients with osteoarthritis (OA) of hand patients and fibromyalgia (FM) patients and evaluate its relationship with RA activity and duration. Patients and methods:The study included 206 patients with RA (34 males, 172 females; mean age 49 years; range 20 to 72 years), 57 patients with FM (57 females; mean age 48 years; range 20 to 71 years), and 50 patients with OA of hand (4 males, 46 females; mean age 43 years; range 43 to 77 years). FA beliefs were assessed with modified Fear-Avoidance Belief Questionnaire (mFABQ). RA patients were dichotomized according to disease activity and disease duration separately; cutoff values were disease activity score 28 of 3.2 and six months of disease activity, respectively. Results: Modified Fear-Avoidance Belief Questionnaire scores were similar in patients with RA, OA of hand, and FM. RA patients in non-remission group had higher mFABQ scores. Moreover, mFABQ scores were similar in RA patients with early and established disease groups. Conclusion: Fear-avoidance beliefs of patients with RA were similar with OA of hand patients and FM patients. However, higher disease activity in RA was related with escalated FA beliefs. Further studies focusing on pathophysiology of FA beliefs in patients with RA are warranted for effective pain management of RA.

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Treat-to-target as an approach in inflammatory arthritis

Abstract: This paradigm is independent of the availability of particular drugs, as the strategy in itself will maximize the benefit for the patient, irrespective of specific medications. Adhering to this strategy in clinical practice will optimize the outcomes in patients with RA.

Cited by 51 publications

References 64 publications

Health status and self‐management in patients with inflammatory arthritis—A five‐year follow‐up study after nurse‐led patient education

Health status and self‐management in patients with inflammatory arthritis—A five‐year follow‐up study after nurse‐led patient education

Evaluation of Proposed Criteria for Remission and Evidence‐Based Development of Criteria for Complete Response in Patients With Chronic Refractory Gout

High Disease Activity May Increase Fear-Avoidance Beliefs in Rheumatoid Arthritis

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