Subclinical Treatment Targets in Rheumatology: Lessons from Randomized Clinical Trials in Rheumatoid Arthritis

Siri Lillegraven; Espen A Haavardsholm

doi:10.1016/j.rdc.2019.07.007

Subclinical Treatment Targets in Rheumatology: Lessons from Randomized Clinical Trials in Rheumatoid Arthritis

Rheum Dis Clin North Am. 2019 Nov;45(4):593-604. doi: 10.1016/j.rdc.2019.07.007.

Authors

Siri Lillegraven¹, Espen A Haavardsholm²

Affiliations

¹ Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, N-0319 Oslo, Norway.
² Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, N-0319 Oslo, Norway; Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Oslo, Norway. Electronic address: e.a.haavardsholm@medisin.uio.no.

PMID: 31564299
DOI: 10.1016/j.rdc.2019.07.007

Abstract

In treat-to-target strategies, choosing the correct target is fundamental to success. The target should be associated with future good outcomes for the patient. Most rheumatic diseases are characterized by inflammation, affecting different tissues depending on the condition. Low-grade, subclinical inflammation is by definition not apparent on clinical examination, but may have significant long-term consequences for the individual. It has thus been debated whether targeting subclinical inflammation would improve long-term outcomes in rheumatoid arthritis. The authors use rheumatoid arthritis as an example to describe and discuss the status of subclinical targets in treat-to-target strategies within rheumatology.

Keywords: MRI; Remission; Rheumatoid arthritis; Subclinical inflammation; Treat to target; Treatment strategies; Ultrasound.

Publication types

Review

MeSH terms

Antirheumatic Agents / pharmacology*
Arthritis, Rheumatoid* / diagnosis
Arthritis, Rheumatoid* / drug therapy
Disease Management
Humans
Patient Care Planning
Randomized Controlled Trials as Topic
Remission Induction / methods
Severity of Illness Index

Substances

Antirheumatic Agents