EULAR26: Pitfalls in Treat-to-Target Save

Real-world or observational data from registries, claims datasets, or electronic health records can enable us to perform large-scale analyses. These findings complement the insights gained from randomised trials, and can help to improve patient care and outcomes.¹ As a key example, EULAR recommends a treat-to-target (T2T) strategy in the management of rheumatoid arthritis and other RMD,^2,3 aiming for clinical remission or low disease activity guided by frequent monitoring and prompt therapy adjustments. But real-world implementation in daily practice remains poorly investigated.

Now, a group in Italy have assessed adherence to T2T in 1,494 outpatient visits for people with rheumatoid arthritis, psoriatic arthritis, or spondyloarthritis – with a retrospective study designed to identify the main barriers to implementation. Findings showed that overall adherence to T2T was suboptimal and significantly lower in people with spondyloarthritis – just 40% compared with rates of over 70% for people with rheumatoid arthritis or psoriatic arthritis. The main obstacle to consistent implementation of a T2T strategy was the lack of recorded disease activity using validated indices in patient records – with this gap identified as the reason for non-adherence in around 90% of cases. In a smaller proportion, non-adherence was due to failure to adapt therapy to disease activity results. The authors also looked to see whether any particular clinical characteristics were linked with rates of T2T adherence. Across all diagnoses, treatment with ts/bDMARDs was strongly associated with better adherence to the strategy. Interestingly, younger age was associated with T2T adherence in rheumatoid arthritis and spondyloarthritis, but not in psoriatic arthritis. Disease duration and number of comorbidities did not show a statistical association.

In conclusion, Giorgia Trignani from the University of Milan in Italy said “These findings highlight potential pitfalls for T2T in clinical practice – and possibly ways to improve implementation and adherence.”

Source

Arese M, et al. Treat-to-target in inflammatory arthritis: a recommended strategy, an incomplete practice. Presented at EULAR 2026; OP0351. Ann Rheum Dis 2026; DOI: 10.1136/annrheumdis-2026-eular.B.4502.