Clinical Edge

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Treat-to-Target and Shared Decision Making in RA Treatment

Implementing treat-to-target through shared decision making is practical in rheumatoid arthritis (RA), a new study found. A questionnaire administered to 157 patients with RA included a self-assessed disease activity measure, an illness belief battery, and a progress evaluation question. These items populated a descriptive model, based on situation awareness (SA) theory. Researchers found:

  • All 6 measures were significantly related to progress evaluation scores.
  • The full SA model accounted for >50% of the variance.
  • The best fitting model included a pain measure at step 1, global disability at step 2, and illness beliefs at step 3.


Falzer PR. Treat-to-target and shared decision making in rheumatoid arthritis treatment: Is it feasible? [Published online ahead of print July 30, 2019]. Int J rheum Dis. doi:10.1111/1756-185X.13664.


In emphasizing a treat-to-target strategy to aggressively control rheumatoid arthritis, providers rely heavily on disease activity scores to decide on the necessity of changing therapy. However, shared decision making necessitates providers and patients to be similarly attuned to disease activity in the same way and to share the same beliefs regarding change of therapy. This study evaluated 157 RA patients from community-based rheumatology practices using the RAPID-4 disease activity scale and analyzing pain, function, and disability, as well as illness perception; all of these scales were related to patients’ perceptions of the discrepancy between their current and desired RA status, suggesting that shared decision-making is feasibly in a treat-to-target strategy. The authors did find, however, that patients’ illness beliefs outweighed disease activity factors in determining the discrepancy measure, suggesting that providers must better understand patients’ beliefs in order to effectively counsel them on treatments and goals. —Arundathi Jayatilleke, MD