Remission is the mission: effects of the implementation of treat-to-target in early rheumatoid arthritis

Rheumatoid arthritis (RA) is characterized by chronic inflammation of the joints. It is important to suppress disease activity as soon as possible. Clinical trials have shown that a treat-to-target (T2T) approach is effective in lowering disease activity and, ultimately, in reaching remission in early RA. T2T aims to control and suppress disease activity to a predefined target as quickly as possible, by protocolised adaptation of the treatment if the target is not met, thereby making optimal use of the currently available medications and computer aids. The question remained whether these beneficial results could be translated into daily clinical practice. The objective of this thesis was to explore the effects of implementing a T2T strategy aiming at remission in early RA. For this purpose, we started the Dutch Rheumatoid Arthritis Monitoring (DREAM) remission induction cohort, the results of which are presented in this thesis. The goal of treatment was to achieve a state of remission (Disease Activity Score in 28 joints (DAS28) < 2.6), thereby following a medication protocol with therapeutic adjustments based on the DAS28. The implementation of a T2T strategy aiming at DAS28 remission resulted in beneficial clinical outcomes in very early RA: the majority of patients achieved remission and this often occurred early in the disease process. This resulted in limited radiological damage, improved physical functioning and improved quality of life. T2T was more effective in achieving remission than usual care treatment. Moreover, T2T was cost-effective. Since T2T and aiming at remission have been shown to be feasible in daily clinical practice, such treatment approaches should be embraced to optimize clinical outcomes for patients with early RA.