For some people with rheumatoid arthritis (RA), routine checkups with their rheu­matologists rarely reveal any important in­formation about their disease. Doctors ask “How are you feeling?” and few other questions, and the appointment usually ends soon thereafter.

 A growing number rheumatologists are now following a different approach for managing patients with RA. It's called “treat to target,” sometimes abbreviated as T2T. Studies show that it's an effective strategy. Rheumatologists who have adopted T2T say it provides a valuable tool for identifying the best therapies for their patients.

Leslie Harrold, MD, a rheumatologist at UMass Memorial Medical Center in Worcester, Mass., follows T2T in her practice.  She starts every patient exam by asking "How are you feeling?" The patient answers on a scale of 0 to 10, with 10 being intense pain. Dr. Harrold checks the patient's joints, noting how many are tender or swollen. She enters her findings on a form, along with her own estimate of the patient's RA status using another 0 to 10 scale, with 10 meaning “very poor." The numbers are added to produce a score that can be compared to previous scores and help determine if the patient's treatment goal is on track. 

Aiming at Targets

The concept of T2T is hardly new. Doctors who treat heart disease, diabetes, and other conditions have long used treatment targets, or goals. For instance, doctors use a blood test called the HbA1c assay to monitor patients’ blood sugar levels. If a patient fails to achieve the HbA1c target, the doctor can change the drug dose or prescribe additional medicine.

 In caring for RA, T2T works this way:

  • The rheumatologist and patient agree on a treatment target, usually remission or very mild symptoms.
  • At each checkup, the doctor uses an objective tool to measure how well the patient is managing his or her RA. Dr. Harrold uses the Clinical Disease Activity Index (CDAI), but others are available.
  • The doctor compares the new test score with the prior one. If the more recent number suggests that the patient’s RA has not improved or is worsening, the doctor may increase his or her medication dose or add or change medications.