“TREAT to target” is a strategy well known in the management of people with diabetes mellitus and hypertension. It is recognized as an extremely useful management goal that everyone can understand and aim to achieve through lifestyle or non-drug measures in addition to medication as appropriate.
A specific target for rheumatoid arthritis has been more difficult to define. The “treat to target strategy” for rheumatoid arthritis has been evolving for the last eight years. There are now disease activity measures which are composite scores which can be used to assess patients. DAS 28 which is “Disease activity score of 28 joints”, and CDAI, “Clinical disease activity index” are the most popular of these. Patients are encouraged to “know their DAS”, to play an active role in achieving a goal agreed upon by the rheumatologist and the patient together.
Management of people with rheumatoid arthritis has improved tremendously over the last 20 years. Not only has there been exciting research that has led to the biologic era and continues to discover more targeted therapies, but we have learnt that using a multidisciplinary patient-centred approach with as early a diagnosis as possible, (sometimes within weeks if we can), leads us to intervene with conventional inexpensive disease-modifying therapy during the “window of opportunity”, before the immune system becomes too “set in its ways”.
The T2T global summit held in London on June 8, brought experts from around the world to discuss the unmet needs in our various countries.
Dr. Amanda King, President of the Caribbean Association for Rheumatology and medical advisor to the St. Lucia Arthritis and Lupus Association, represented the Caribbean at the summit.
She contributed to the discussion, saying that most St. Lucian and Caribbean patients cannot afford the biologics and newer therapies and we look forward to collaborative efforts between pharmaceutical companies, insurance companies and government to make them more affordable. Also biosimilars are becoming available and promise to be less expensive.
However, she is optimistic that with more education of patients, the public and health professionals, as planned by herself, the Ministry of Health and the St. Lucia Arthritis and Lupus Association, we will diagnose patients earlier, giving them the best opportunity possible with conventional disease-modifying medication and holistic care, to achieve remission and potentially be cured.
The role of self-management programmes in the management of Rheumatoid Arthritis can never be understated and through SLALA, St. Lucia is fortunate to be a pioneer in the Caribbean, as the association continues to run the Viv Byen self- management programme throughout communities in St. Lucia.
Persons seeking more information on Rheumatoid Arthritis as well as the Viv Byen programme, can contact the St. Lucia Arthritis and Lupus Association, 459-0092 or the Bay Medical Centre, 459-2640.