Treat to Target (T2T) in Rheumatoid Arthritis (RA) within the Consortium of Rheumatology Researchers of North America (CORRONA) network

Evidence-based guidelines recommend that rheumatoid arthritis (RA) treatment should achieve clinical remission or low disease activity, a goal that has been called ‘treat to target’ (T2T). Despite available therapeutics, data from the Consortium of Rheumatology Researchers of North America (CORRONA) show that <50% of patients with moderate/high disease activity receive guideline recommended treatment escalation. Working with patients and rheumatologists, we will assess their barriers to achieving T2T and develop a 2-component educational intervention (for both patients and physicians) to improve T2T adherence.  Barriers will be identified through nominal groups with patients and physicians, their prevalence estimated through patient surveys, and the interventions will be designed using Adult Learning Theory and Bandura’s Social Cognitive Theory. The physician-directed intervention will incorporate patient-derived qualitative research results and will coach rheumatologists in effective strategies to guide and empower their patients to achieve T2T treatment goals. The patient-directed intervention will include education about the rationale for T2T, use of patient reported outcomes (PROs) to assess health status, differences between disease activity markers and symptoms, and the experiences of other patients who achieved T2T goals. We will pilot-test the interventions in eight rheumatology practices and 200 patients within the CORRONA network using a web/mobile interface, and we will evaluate its effectiveness in improving patient willingness to adopt T2T and achieving remission or low disease activity. This project builds on well-established collaborations between the University of Alabama at Birmingham (UAB), Northwestern University, CORRONA, and Medscape, including experts in rheumatology, epidemiology, risk communication, decision-making, and adult education.