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Where are we with implementation of treat to target (T2T) recommendations/guidelines in clinical practice?

Dear Colleague,

We have been working in the last weeks to simplify your access to resources on the website. There are now 8 tabs on the home page, together with videos pertinent to recent newsletters. On the video channel, we’ve also added podcasts with the audio for each video.

For this newsletter, we’re updating content on RA patient management with videos, links to various country-specific guidelines (APLAR, Finland), and commentaries that describe practical aspects for the application of EULAR and ACR recommendations/ guidelines.

In a video interview at ACR2016, Dr John Davis, Assistant Professor of Medicine at Mayo Clinic, Rochester, Minnesota offers practical perspective on application of treat-to-target, based on experience in a community-based clinic. He notes that about 30% of early RA patients will achieve LDA on MTX alone. He suggests adding additional conventional DMARDs or TNFi if LDA is not apparent within 3-6 months. In established RA, one needs to consider other reasons for “high” disease activity. Especially useful is discussion of differential diagnosis when MD and patient disagree on global disease activity. Considerations include fibromyalgia, regional pain syndromes, gout or CCPD disease, OA, neuropathies.  Consider ultrasound or MRI if active synovitis is in doubt. IN terms of biomarkers, about 40% of patients with active RA will have a normal CRP.  "There’s plenty of room in the guidelines for good clinical judgement!"

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We interviewed Professor Rene Westhovens (University of Leuven, Belgium) at the British Society of Rheumatology a few weeks ago. Because the CARE-RA study was conducted primarily in clinical practice sites in Belgium, he describes the application of the results of to clinical practice in a video posted on the home page. CARE-RA is a fully investigator funded randomized controlled clinical trials evaluating 3 conventional DMARD strategies to induce and maintain remission in early RA patients regardless of poor prognostic features. In comparison to a “high dose” corticosteroid (CS) with MTX induction regimen, a “mid dose” CS regimen provided comparable remission rates (60+%) with a more favorable side effect profile. Prof Westovens highlights the cost-effectiveness implications of this result, and at the same time stresses the critical importance to identify strategies that address the ~ 40% of patients who need more effective therapies.

Watch the video

In the coming weeks we’ll be presenting videos and content aimed at providing resources enabling selection of therapies for patients with particular comorbidities, taking into consideration a range of demographics such as duration of disease, prior therapies, and joint damage.

We look forward to your feedback.

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