Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Curr Opin Rheumatol. 2018 May;30(3):282-287. doi: 10.1097/BOR.0000000000000484.
There has been a trend over time to aim for stricter treatment targets in the treatment of rheumatoid arthritis (RA). We reviewed recent literature to attempt to identify the optimal target in treat-to-target strategies in RA.
Achieving lower disease activity was shown to be beneficial, but few studies directly compared the effect of aiming for different treatment targets. Based on the limited available evidence, aiming for remission seems to result in more patients achieving (drug-free) remission than aiming for low disease activity (LDA), but it does not seem to result in better physical functioning. There are indications that adherence to a remission targeted protocol can be lower. In randomized trials in which LDA or remission were compared with ultrasound remission targets, treatment targeted at ultrasound remission was associated with more intensive treatment, but it did not result in better clinical or imaging outcomes.
There were no benefits of aiming for ultrasound remission in RA-patients. To decide whether remission or LDA is the best target in the treatment of RA-patients, a randomized clinical trial comparing both targets would be needed. On an individual level, cotargets such as functional ability should be considered.
随着时间的推移，类风湿关节炎（RA）的治疗目标逐渐趋于严格。我们查阅了最新文献，试图确定 RA 达标治疗策略中的最佳目标。
较低的疾病活动度已被证明有益，但很少有研究直接比较不同治疗目标的效果。基于有限的现有证据，与低疾病活动度（LDA）相比，达到缓解似乎会使更多患者实现（无药物）缓解，但似乎不会导致更好的身体功能。有迹象表明，对缓解目标方案的依从性可能较低。在将 LDA 或缓解与超声缓解目标进行比较的随机试验中，针对超声缓解的治疗与更强化的治疗相关，但并未导致更好的临床或影像学结果。
在 RA 患者中，针对超声缓解的治疗没有获益。要确定缓解或 LDA 哪个是 RA 患者治疗的最佳目标，需要进行比较这两个目标的随机临床试验。在个体层面上，应考虑功能能力等共同目标。
