Ruderman Eric M, Nola Kamala M, Ferrell Stanley, Sapir Tamar, Cameron Davecia R
Rheumatology Clinic, Northwestern Department of Medicine, Northwestern University, Chicago, IL, USA.
J Manag Care Pharm. 2012 Nov-Dec;18(9):1-18. doi: 10.18553/jmcp.2012.18.S9-A.1.
Recent publications have proposed revisions to disease classification criteria, new definitions of remission, and guidelines for implementing treat-to-target strategies for the management of patients with rheumatoid arthritis (RA). Despite developments leading to this practice-changing approach, the concept of treat to target has not yet been widely accepted or implemented in managed care. At the 24th Annual Meeting Expo of the Academy of Managed Care Pharmacy (AMCP), held in San Francisco on April 18, 2012, a 4-hour activity titled Incorporating New Treat-to-Target Guidance and Strategies in RA: What Managed Care Needs to Know was conducted in association with AMCP's Continuing Professional Education Partner Program. The practicum featured didactic presentations, a roundtable session, and an expert panel discussion detailing research evidence, ideas, and discussion topics central to the treat-to target concept in RA and its applications to managed care.
To (a) discuss recent advances in RA management, (b) evaluate strategies to optimize the use of disease-modifying antirheumatic drugs(DMARDs), and (c) explain how to incorporate the treat-to-target paradigm in contemporary clinical practice and clinical care models in order to improve outcomes for patients.
The past decade has seen a tremendous amount of change in the field of rheumatology. The early and aggressive treatment of RA, including the use of novel biologic agents, has been shown to have favorable patient outcomes in reducing synovial inflammation, delaying joint damage,and maintaining functional status, leading to the recently published revisions in classification criteria and updated recommendations for the utilization of conventional DMARDs and biologic agents in the treatment of RA. The revised classification criteria can be used to diagnose RA patients at an earlier point in the disease course by placing greater emphasis on clinical features that manifest early in the disease process. The concept of achieving tight control of RA and treating to target has been well established and utilizes early diagnosis, aggressive treatment, and regular monitoring,leading to positive outcomes in a significant number of patients with RA who achieve current treatment goals of low levels of disease activity or clinical remission.
近期的出版物对类风湿关节炎（RA）患者管理的疾病分类标准、缓解的新定义以及实施达标治疗策略的指南提出了修订建议。尽管这些进展带来了这种改变实践的方法，但达标治疗的概念在管理式医疗中尚未得到广泛接受或实施。在2012年4月18日于旧金山举行的美国管理式医疗药师学会（AMCP）第24届年会博览会上，与AMCP的继续职业教育合作伙伴计划联合举办了一场为期4小时的活动，主题为“将新的达标治疗指南和策略纳入类风湿关节炎治疗：管理式医疗需要了解什么”。该实践活动包括讲授式演讲、圆桌会议以及专家小组讨论，详细阐述了与类风湿关节炎达标治疗概念及其在管理式医疗中的应用相关的研究证据、观点和讨论主题。
（a）讨论类风湿关节炎管理的近期进展；（b）评估优化改善病情抗风湿药物（DMARDs）使用的策略；（c）解释如何将达标治疗模式纳入当代临床实践和临床护理模式，以改善患者的治疗效果。
在过去十年中，风湿病领域发生了巨大变化。类风湿关节炎的早期积极治疗，包括使用新型生物制剂，已被证明在减轻滑膜炎症、延缓关节损伤和维持功能状态方面对患者有良好的治疗效果，这导致了最近发布的分类标准修订版以及关于在类风湿关节炎治疗中使用传统DMARDs和生物制剂的更新建议。修订后的分类标准通过更加强调疾病过程早期出现的临床特征，可用于在疾病进程的更早阶段诊断类风湿关节炎患者。实现类风湿关节炎的严格控制并进行达标治疗的概念已得到充分确立，并利用早期诊断、积极治疗和定期监测，使大量实现低疾病活动水平或临床缓解这一当前治疗目标的类风湿关节炎患者取得了积极的治疗效果。
