Dr Daniel Aletaha is a head of the Division of Rheumatology at Medical University of Vienna, Austria, member of international task forces that endorsed the treat-to-target recommendations and EULAR guidelines for the management of rheumatoid arthritis and psoriatic arthritis, and lead author of the 2010 classification criteria for rheumatoid arthritis.
If you were to name the 3 most important recent advances in the management of rheumatoid arthritis, what would they be?
Daniel Aletaha, MD, MS, MBA: So, let me think out loud. Three of the very important, let’s say, very important advances in rheumatoid arthritis (RA) management… They probably include drugs, of course, and we know [that] this is a very rapidly evolving field—we have new compounds, we have Janus kinase (JAK) inhibitors as a new oral [drug] class, but we also have a lot of biosimilars, and even some of the JAK inhibitors soon becoming generic. So, this field is currently very much in progress and this is certainly something that every year you can claim is an advance, but we’re expanding our armamentarium every year.
In terms of the strategy, [the] treat-to-target [strategy], of course, remains the most important strategy. We learned a lot in the last couple of years: that it’s good to have a clinical remission target, that we should not accept higher levels of disease activity, but that we also do not need to go to subclinical remission, which will potentially overtreat many of our patients.
And finally, I think lots of data have accumulated about what to do in patients in remission. And that’s a very positive thing that we start thinking about this and it seems to be reasonable for many of our patients to really taper off their medication together with the rheumatologist and maybe at some point get something like a disease-free state with little or even no therapy. Maybe this is still a little bit the future, but we’re on the right way there.