John, I think your views are those of most rheumatologists. But this study showed that most rheumatologists pay lip service to T2T- we do a measure but dont do T2T. The stark raving truth is that T2T (if practiced) leads to 4 fold higher DAS remissions and ACR70 rates even when using modest DMARDs like HCQ and MTX. IT removes the art of medicine (Ill know it when I see it thinking) and replaces it with a bankable sure-fire use of metrics. Rheums need to go NOT with what works for me or what we think works best, but instead go with an easier mathematical approach to the highly difficult problem of RA management. This article could be viewed as the title states - "T2T is a Bust!" or it could be viewed that Rheums getting a failing grade on what they should easily and routinely do. When and if the day comes that T2T will be required to approve the use of new drugs, we may change our tune - after at least 6 mos of griping, crying and cursing. What do you think? JC