Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110, Ioannina, Greece.
Clin Rheumatol. 2020 Apr;39(4):1363-1368. doi: 10.1007/s10067-020-05001-x. Epub 2020 Feb 22.
The treatment of inflammatory arthritides has been changed dramatically in the past two decades with the introduction of the biological (b) disease-modifying anti-rheumatic drugs (DMARDs) as well as the targeting synthetic (ts) DMARDs that can be used as monotherapy or in combination with conventional synthetic (cs) DMARDs. The concept of treat to target (T2T) and tight control monitoring of disease activity represents a therapeutic paradigm of modern rheumatology. In rheumatoid arthritis (RA), this treatment approach has proven to be effective in many clinical trials and is now a well-established approach. The most common treatment strategies rely on the combination of csDMARDs (mainly methotrexate, sulfasalazine and hydroxychloroquine). This comes from different studies which compare the outcomes of combination therapies versus csDMARD monotherapy or versus methotrexate plus biologics in early RA patients. Here, we review the literature of the most important T2T studies for RA patients. The results showed that a tight control strategy appears to be more important than a specific drug to control RA. T2T approach aiming for remission or low disease activity can be achieved in early RA patients using less expensive drugs in comparison to newer drugs and this may need to be recognised in the future recommendations for the management of RA. KEY POINTS: • Tight-control and treat-to-target (T2T) strategies are the cornerstone in achieving remission or low disease activity in rheumatoid arthritis (RA) • A plethora of clinical trials has confirmed the efficacy of csDMARDs when the tight-control and T2T strategies are applied • T2T and tight-control strategies are a less expensive option in comparison to newer drugs and may be recognised in the future recommendations for the management of RA. • Treatment decisions and strategies are more important than just the drugs.
在过去的二十年中，随着生物（b）疾病修饰抗风湿药物（DMARDs）以及可单独使用或与传统合成（cs）DMARDs 联合使用的靶向合成（ts）DMARDs 的引入，炎症性关节炎的治疗发生了巨大变化。治疗目标（T2T）和疾病活动密切监测的概念代表了现代风湿病学的治疗范例。在类风湿关节炎（RA）中，这种治疗方法已被多项临床试验证明有效，现已成为一种成熟的方法。最常见的治疗策略依赖于 csDMARDs（主要是甲氨蝶呤、柳氮磺胺吡啶和羟氯喹）的联合治疗。这来自于不同的研究，这些研究比较了联合治疗与 csDMARD 单药治疗或早期 RA 患者中 csDMARD 加生物制剂的结果。在这里，我们回顾了 RA 患者最重要的 T2T 研究文献。结果表明，与控制 RA 相比，紧密控制策略似乎比特定药物更为重要。与新型药物相比，使用较便宜的药物可以在早期 RA 患者中实现 T2T 目标的缓解或低疾病活动度，这在未来 RA 管理的建议中可能需要得到认可。关键点：• 紧密控制和治疗目标（T2T）策略是实现类风湿关节炎（RA）缓解或低疾病活动度的基石• 大量临床试验证实了 csDMARDs 在应用紧密控制和 T2T 策略时的疗效• T2T 和紧密控制策略是比新型药物更经济的选择，在未来 RA 管理的建议中可能会得到认可• 治疗决策和策略比药物更重要。
