RA Treat-to-Target

Persistent moderate disease activity can cause long-term joint damage in rheumatoid arthritis patients,…

“Fast-and-Furious”, “Early-and-Aggressive”, “Hit-Early-Hit-Hard”: whatever pithy catchphrase you choose to call it, early treatment-to-remission forms a pillar of T2T strategy.
Achieving early disease control means faster pain relief, restoration of function, prevention of joint damage, and perhaps increase the likelihood of going off all medications eventually.

DMARDs Combo Cuts Time to First Remission in RA

A three-therapy protocol did not prove superior for achieving remission in rheumatoid arthritis (RA) patients after 1 year, but the regimen did lead to a shorter time until first remission versus a step-up approach, according to an analysis of the DREAM registry.

The other pillar of T2T is to achieve remission with “Whatever-It-Takes”. It may not necessarily be the costly biologics or JAK inhibitors, much as the big pharmas may want to have you believe. Steroids can induce remission just as well (albeit in higher doses with the attendant side-effects), and combination csDMARDs can achieve good maintenence of remission.

Mayo Clinic’s Timothy Niewold, M.D., speaks with Rheumatology Network about the latest innovations…

With the slew of targeted therapies currently in play to treat RA, precision medicine (maximising efficacy while limiting collateral damage) is a reality in clinical practice.
The unmet need is in the dearth of biomarkers to inform the treating rheumatologist on which therapy will work best for which patient. This is the next research frontier of personalised medicine.

A Long and Winding Road Ahead in Personalized Medicine

Genetics research shows great promise for personalized treatment in rheumatology — but diagnostic and prognostic gene tests are years away.

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Once the target of sustained remission is achieved, drug-free or otherwise, the next target is RA prevention. Will it be a pre-emptive strike at preclinical disease, or a vaccination programme for at-risk individuals? Till then, it’s good to dream.

Recent advances in research into the earliest phases of RA have provided additional insights into the processes leading from the healthy to the diseased state. These insights have opened the way for the development of preventive strategies for RA, which represents a significant paradigm shift from t…