THE MANAGEMENT of rheumatoid arthritis (RA) has significantly evolved, moving beyond the mere application of clinical trial results to a more nuanced approach that integrates various factors influencing patient care. This evolution acknowledges the complexity of RA treatment, where the focus is not solely on drug efficacy, but also encompasses safety profiles, patient preferences, and health-economic considerations. With the availability of multiple disease-modifying anti-rheumatic drugs (DMARDs), it has become crucial to develop strategies that ensure optimal drug selection and usage tailored to each individual patient.
One of the key challenges in current RA management is the ‘precision gap,’ where existing precision medicine strategies have not sufficiently guided treatment choices in real-world clinical practice. Rather than solely targeting the ‘maximum’ level of success, which can often lead to frustration and the labelling of patients as ‘difficult to treat’, it is essential to adopt a more realistic and balanced approach. This involves setting treatment goals that prioritise improved patient compliance and quality of life over aspirational outcomes.
Contemporary management strategies should shift towards a holistic framework, which includes assessing the individual patient’s multimorbidity and treatment preferences, alongside safety profiles of available therapies. Such an approach, termed ‘therapeutic matchmaking’, aims to identify the most suitable treatment options for patients based on a comprehensive understanding of their unique circumstances.
Moreover, treatment targets must be ambitious yet realistic. Striving for overly ambitious goals can often lead to excessive effort without corresponding benefits. The proposed ‘smart-to-target’ approach encourages healthcare providers to define achievable targets that consider the additional burden required to reach them, thereby fostering a more sustainable treatment journey for patients.
Ultimately, the goal remains the same: maximising health-related quality of life for individuals living with RA. By focusing on optimal balance rather than superlative achievements, healthcare providers can create a more effective and patient-centred management strategy for this complex condition.
Reference
Konzett, V., Aletaha, D. Management strategies in rheumatoid arthritis. Nat Rev Rheumatol. 2024;DOI:10.1038/s41584-024-01169-7.
