Monitoring rheumatoid arthritis

Abstract

In this thesis we focussed on so-called 'treat to target' therapy in rheumatoid arthritis (RA). Treat to target relies on repetitive measurements of disease activity using a composite score that incorporates signs of disease activity such as laboratory results, findings of physical joint assessments, and the opinion of the patient. It is recommended that rheumatologists intensify treatment when a predefined level of disease activity, the target, has not yet been achieved. The implementation of treatment to target in daily practice depends on the faith of the rheumatologist and the patient to rely on a disease activity composite index (for instance the DAS) rather than on some judgemental estimate of disease activity ('the patient is doing well'). It also relies on a consensual opinion that a pre-set treatment target (for instance a DAS=>1.6) meaning clinical remission) is a desirable as well as an achievable target, and especially on the willingness to intensify medication every time the treatment target has not been achieved. Several aspects of treat to target, in particular a plea for the improvement of the rheumatologists' awareness about and the implementation of treat to target recommendations in daily clinical practice, are discussed in the thesis