What is the optimal target for treat-to-target strategies in rheumatoid arthritis?

There has been a trend over time to aim for stricter treatment targets in the treatment of rheumatoid arthritis (RA). We reviewed recent literature to attempt to identify the optimal target in treat-to-target strategies in RA.

Achieving lower disease activity was shown to be beneficial, but few studies directly compared the effect of aiming for different treatment targets. Based on the limited available evidence, aiming for remission seems to result in more patients achieving (drug-free) remission than aiming for low disease activity (LDA), but it does not seem to result in better physical functioning. There are indications that adherence to a remission targeted protocol can be lower. In randomized trials in which LDA or remission were compared with ultrasound remission targets, treatment targeted at ultrasound remission was associated with more intensive treatment, but it did not result in better clinical or imaging outcomes.

There were no benefits of aiming for ultrasound remission in RA-patients. To decide whether remission or LDA is the best target in the treatment of RA-patients, a randomized clinical trial comparing both targets would be needed. On an individual level, cotargets such as functional ability should be considered.