Treating rheumatoid arthritis to target: an international initiative

Excerpt

What do the following have in common: low-density lipoprotein (LDL), hemoglobin A1C, and blood pressure? Each is a parameter that is used as a therapeutic target in disease management: LDL for coronary artery disease (CAD), hemoglobin A1C for diabetes, and blood pressure for both diabetes and chronic kidney disease. The approach of “treating to a target” is not a new concept in clinical medicine. Indeed, such a goal-directed therapeutic strategy is already the standard approach in many specialties, and failure to achieve the set target predicts both morbidity and mortality. For example, the goal of reducing LDL is widely accepted and adhered to by both cardiologists and primary care physicians (PCPs), with the target LDL goal determined by the number of CAD risk factors that are present in an individual patient. The Joint National Commission (JNC) 7 blood pressure guidelines are also commonly followed by medical professionals. Physicians have come to recognize that blood pressures less than 140/90 mmHg must be targeted in otherwise healthy individuals and that blood pressures less than 130/80 mmHg must be the goal of treatment in all patients with diabetes or chronic kidney disease (CKD) to reduce the risk of myocardial infarction, stroke, and heart failure. Finally, both endocrinologists and PCPs understand the importance of achieving a hemoglobin A1C level as close to 6% as possible, and use this parameter as an indicator of the success of their therapeutic strategy to achieve “tight” control of a patient’s diabetes in the outpatient setting. …