Rheumatoid arthritis: treating to target with disease-modifying drugs

Treating to target is an established concept in a number of long-term conditions, which aims to improve outcomes and prevent disease progression. Treatment targets in rheumatoid arthritis (RA) are to control the signs and symptoms of significant inflammatory disease activity, with the ultimate goal of remission from disease. Assessment of patients' disease activity includes clinical examination of the number of swollen and tender joints, combined with measurement of inflammatory markers and visual analogue scales of patients' overall wellbeing and symptoms. Early initiation and rapid dose escalation of disease-modifying anti-rheumatic drugs (DMARDs) has been shown to be crucial to optimizing disease control, protecting joints from destruction and preserving health-related quality of life. Corticosteroids can be prescribed for oral use but are often given by intra-muscular or joint injection in times of flare to minimize the risks of side effects. The rational use of non-steroidal anti-inflammatory drugs and analgesia remains important to symptom management throughout the patient journey. In part two of this three-part series, the concept of treating to target in rheumatoid arthritis is outlined, including the role of the nurse in optimizing outcomes and an overview of treatment options using conventional DMARDs. Part three will cover the use of biologic agents, which have increased treatment options for RA, but their use is reserved for patients with severe disease activity who have failed to respond to adequate trials of DMARDs.