Video

In our centre, we have been treating our patients since 2009 already in a treat-to-target strategy. Really, the early target would be the absence of fever, so the resolving of the fever, the spiking fever. And then at three months, getting patients, if possible, in clinical and active disease without glucocorticoids. And the good thing is that this is only a mono-centre experience, but this strategy has been more or less replicated by other centres. And now we really agreed together that it was good to have early targets in the disease course, in the treatment course, and also a bit more on the long term (Vastert, 2024).

So, what we agreed here was that one week, patients should have resolution of fever and a reduction of CRP levels by at least 50%. And at the time point of one month, four weeks after the start of therapy, patients should not only have no fever, but also a reduction of the active and swollen joint count by at least 50%, a normalized CRP level, and a rating of less than 20 on a scale of 0 to 100 on a visual analogue scale of the physician, and preferably also of the patient, although this is, of course, a bit based on a discussion, I would say. And on the longer term, so after three months, patients should maintain clinical and active disease with low or no glucocorticoids, but at least lower than less than 0.1 or 0.2 milligrams per kilogram per day (Fautrel, 2024; Vastert, 2024).