Treat to Target Care
One of the most interesting topics discussed at the conference my local Arthritis Foundation office held was “Treat to Target” (T2T). Dr. Stanford Peng explained that it is a way of focusing the care and treatment of a condition on a specific target. As a patient, it seems like an obvious way to map care, but it turns out that many rheumatologists do not follow this process or intend to do so in the future. Much of the reason for this is because T2T can be harder to implement in types of arthritis or conditions like fibromyalgia. This is because of the lack of treatments that work well for everyone and not having extremely reliable measurement tools to track progress and results.
An example of T2T care working well is in a patient with gout, a form of arthritis. A patient with gout can be shown to be in remission through lab work looking at the levels of uric acid in the body. With T2T care gout patients often need a higher dosage of medication (often allopurinol) to hit their target (remission) than they would normally be prescribed to manage their condition. By reaching for and achieving this target many patients are able to be “disease free” for months. Who wouldn’t love that?!
In conditions where remission is more difficult or currently impossible to achieve, a different target can be created. For instance, having lower disease activity (found by measurements) or setting a target like being able to work 3 days a week without flaring. As you’re working toward the target, you re-evaluate treatments if the target is not getting closer. One thing doctors need to be careful of is not over treating the patient though. This is especially important for those taking medicines with more extreme side effects, such as ones that suppress the immune system. In some cases increased side effects (if that is the only treatment choice left) may not be worth achieving the original target.
Stay tuned for more from the 2012 Arthritis Foundation Conference.
Have you ever crated targets or goals with your doctor?