Reconciling treat-to-target with clinical practice: The challenge and how to meet it

Treat-to-Target (T2T) has become the standard treatment approach for rheumatoid arthritis. In concept, T2T is a straightforward 2-stage procedure: Evaluate progress, then escalate treatment if a scale score exceeds a threshold. However, guidelines require T2T to be implemented collaboratively and with discretion. Studies have raised concerns about its feasibility for clinical practice and identified differences between how patients and providers evaluate progress as an impediment. Unfortunately, most studies fail to appreciate that progress assessment is a distinct process and not compatible with selection-based decision models. This brief report identifies 5 ways that progress and selection decisions differ. Having more appropriate methods and models will enable investigators, educators, and practitioners to focus on how commonalities between patients and providers are established and maintained, and how disagreements are overcome.