Treat-to-target and safe tapering strategies should continue to be essential in the management of rheumatoid arthritis (RA) during the coronavirus disease 2019 (COVID-19) pandemic, according to a commentary published in Lancet Rheumatology.
The National Institute for Health and Care Excellence COVID-19 guidelines suggested that face-to-face patient consultations should be avoided, unless patients present with a disease flare; patients with “stable” disease should be treated remotely. However, the definition of “stable” disease may be misguided, the authors of the commentary noted. Even amid the pandemic, treat-to-target strategies should be preserved to maximize the number of patients achieving remission.
Treat-to-target refers to arthritis management that prioritizes low disease activity or remission. With treat-to-target, patients set specific management targets and undergo frequent laboratory tests and clinical examinations. If disease targets are not met, different treatment strategies are adopted. Research has suggested that up to 50% of patients can achieve remission through treat-to-target.
While focused efforts may be taken to mitigate COVID-19 risk, rheumatologists should prioritize treat-to-target for their patients. Although patients with minimal disease activity or remission may be good candidates for remote management, patients who have yet to reach their treatment goals should be considered for clinic visits.
Patients undergoing dose tapering may also require clinic visits, the authors added. Clinical examination of the joints is often necessary to detect flares. In addition, in the context of the pandemic, some patients may be self-tapering because of fears of their drugs increasing the risk for COVID-19. While early observational data has suggested that disease-modifying antirheumatic drugs do not increase risk for COVID-19, research is still ongoing. Clinicians should make every effort to monitor patients who are tapering and minimize the risk for disease flares.
Ideally, development of “one-stop shop” clinics may be the best way to manage RA while minimizing hospital contact. While efforts to maintain physical distancing are essential, patients with RA should not have to endure disease flares as a result.
“Treat-to-target and safe tapering strategies should continue to be essential in the management of rheumatoid arthritis, regardless of new approaches that streamline the patient experience and reduce the number of hospital visits,” the authors concluded.
Yeoh SA, Ehrenstein MR. Are treat-to-target and dose tapering strategies for rheumatoid arthritis possible during the COVID-19 pandemic? Lancet Rheumatol. 2020;2(8):e454-e456.