For many people with rheumatoid arthritis, remission isn’t a dream-it’s a realistic goal. But getting there isn’t about hoping for the best or waiting for symptoms to fade. It’s about a proven, structured approach called treat-to-target (T2T). This isn’t just another buzzword. It’s a shift in how rheumatoid arthritis is managed, backed by over a decade of clinical trials and real-world data showing it works-when done right.
What Treat-to-Target Really Means
Treat-to-target isn’t about guessing whether your RA is under control. It’s about measuring it. Every few weeks or months, your doctor uses a simple score-usually DAS28-to check how active your disease is. DAS28 counts swollen and tender joints, blood markers like CRP or ESR, and how you’re feeling overall. If the score is above 2.6, you’re not in remission. If it’s between 2.6 and 3.2, you’re in low disease activity. And if you’re below 2.6? That’s remission. The key isn’t just measuring. It’s acting. If you’re not hitting your target after 3 months, your treatment changes. No waiting. No hoping it gets better on its own. You adjust meds, increase doses, or switch drugs. This isn’t trial and error. It’s a roadmap.Why This Works Better Than Old Ways
Ten years ago, many doctors waited until symptoms got worse before changing treatment. They’d give methotrexate, wait six months, see if things improved, and maybe add another drug if things got worse. By then, joint damage might already be happening. T2T flips that. It’s aggressive, early, and data-driven. The DREAM trial showed that in early RA, 58% of patients reached remission after a year using T2T. In the TICORA trial, 47% reached remission with T2T compared to just 28% with usual care. The BeSt trial found 61% remission at two years with protocol-driven treatment versus 37% without. These aren’t small differences. They’re life-changing. People on T2T have less joint damage, better mobility, and higher quality of life. One patient in a CreakyJoints forum wrote: “After switching to a rheumatologist who uses DAS28 every visit, I reached remission in 6 months-after three years of pain.” That’s not luck. That’s strategy.How Treatment Escalation Actually Works
T2T isn’t just about checking scores. It’s about having a clear plan for what to do next. Most people start with methotrexate-10 to 25 mg a week. If after 3 months, DAS28 is still above 3.2, you add another conventional drug. That’s often triple therapy: methotrexate + sulfasalazine + hydroxychloroquine. If that doesn’t work, you move to biologics or JAK inhibitors. Biologics include TNF blockers like adalimumab and etanercept, IL-6 inhibitors like tocilizumab, and JAK inhibitors like baricitinib and upadacitinib. These aren’t last-resort drugs anymore. With T2T, they’re part of the early toolkit. The goal isn’t to jump to the strongest drug right away. It’s to find the lowest effective dose that gets you to remission. That’s why the protocol matters. No one-size-fits-all. But every step has a rule.
What the Data Says About Success Rates
Numbers don’t lie. Here’s what real studies show:- In the DREAM trial, 47% reached remission at 6 months. By 12 months, it jumped to 58%.
- In the CAMERA-II trial, 50% were in remission at 2 years with T2T. Only 28% were in the control group.
- For early RA (symptoms under 1 year), 61.7% reached remission after 3 years with T2T. Without it, only 30% did after 1 year.
- Even in established RA, T2T improved low disease activity rates to 65% versus 52% in routine care.
Why It’s Not Working Everywhere
Despite the data, T2T isn’t happening in every clinic. A 2022 study found that only 40.8% of rheumatologists and patients agreed on a treatment goal. That’s a huge gap. Some doctors still rely on gut feeling. Others don’t have time to do joint counts or calculate DAS28 scores. Patients might skip appointments or stop taking meds because they feel “fine.” And here’s the real problem: not everyone can reach remission. Some people have more aggressive disease. Others have side effects that limit treatment options. That’s why the 2022 EULAR update added a key note: targets should be individualized. For some, low disease activity is enough. For others, remission is the goal. The point isn’t perfection-it’s progress.What You Need to Make T2T Work for You
If you want T2T to work, you need to be part of the plan.- Ask your doctor: “What’s my DAS28 score?” If they don’t know, ask for it. If they say they don’t use it, ask why.
- Track your symptoms between visits. Keep a simple log: swollen joints, morning stiffness, fatigue. Bring it to every appointment.
- Don’t stop meds just because you feel better. Remission doesn’t mean the disease is gone-it means it’s quiet. Stopping treatment can bring it back.
- Use tools. The ACR’s Treat to Target app is free and helps calculate DAS28. The T2T-Rheuma website has guides in 12 languages.
The Future: Digital Tools and Personalized Targets
T2T is evolving. New trials like DART are testing smartphone apps that track joint pain, swelling, and fatigue daily. These tools feed real-time data to doctors, making adjustments faster. Soon, doctors might use genetic or blood biomarkers to predict which drug will work best for you before you even start. The goal isn’t just to treat to a target-it’s to predict the best path to get there. But for now, the most powerful tool is still the one you already have: consistent measurement, timely changes, and a clear goal. Remission isn’t magic. It’s method.What If You Can’t Reach Remission?
Not everyone will get there. And that’s okay. Dr. Paul Emery, a leading rheumatologist, reminds us: “The focus should sometimes shift to minimizing impact on quality of life.” If your joints are stable, pain is low, and you can walk, work, and sleep without major disruption, you’re doing well-even if your DAS28 is 3.1. The goal isn’t to beat yourself up over a number. It’s to live well. T2T gives you the tools to get there. But it also gives you permission to redefine success.Final Thought: This Isn’t Just About Arthritis
T2T changed how we treat rheumatoid arthritis. But its real power is in proving that chronic disease doesn’t have to be managed reactively. With clear goals, regular check-ins, and timely action, even the most stubborn conditions can be controlled. You don’t need to wait for the next breakthrough. You just need to ask the right questions, demand the right measurements, and stick with the plan. Remission isn’t out of reach. It’s just a target away.Can rheumatoid arthritis go into remission without medication?
In rare cases, some people with very early or mild RA may experience long-term remission after stopping medication, especially if they reached remission quickly with aggressive treatment. But for most, stopping drugs leads to flare-ups. Remission on medication means the disease is controlled-not cured. Doctors rarely recommend stopping treatment unless there’s sustained remission for over a year, and even then, it’s done cautiously with close monitoring.
How often should DAS28 be checked during T2T?
During active disease or after a treatment change, DAS28 should be checked every 1 to 3 months. Once you’ve reached low disease activity or remission and are stable, checks can drop to every 3 to 6 months. Waiting longer than 6 months without monitoring increases the risk of hidden flare-ups and joint damage.
What if my doctor doesn’t use DAS28?
Ask if they use other validated tools like CDAI or SDAI. If they use none and rely only on how you feel or basic blood tests, you’re not getting full T2T care. You can request a referral to a rheumatologist who follows EULAR or ACR guidelines. Many clinics now use electronic templates that auto-calculate scores-ask if your doctor uses one.
Are biologics always needed for T2T?
No. Many people reach remission with methotrexate alone or triple therapy (methotrexate + sulfasalazine + hydroxychloroquine). Biologics and JAK inhibitors are used when conventional drugs fail after 3 months. They’re not first-line for everyone-but they’re part of the escalation plan. Starting them early in high-risk patients can improve outcomes.
Is T2T only for early RA?
No. While T2T works best in early RA, it also helps people with long-standing disease. Studies show that even after years of uncontrolled RA, switching to T2T can improve disease activity, reduce pain, and slow further joint damage. The goal shifts from remission to low disease activity in these cases-but the process is the same: measure, adjust, repeat.
Does T2T cost more than regular care?
Initially, yes-more visits and stronger drugs increase costs. But long-term, T2T saves money. Fewer hospitalizations, surgeries, and disability claims offset the upfront expenses. Studies in the UK found T2T costs about £15,200-19,800 per quality-adjusted life year gained, which is considered cost-effective by health agencies. Preventing one joint replacement can save tens of thousands.
