In the ORCHESTRA trial framework, the treat-to-target (T2T) strategy in rheumatoid arthritis aims to achieve which primary target by 6 months if remission is not achieved?
- A VAS pain score < 3 on a 10-point scale
- B DAS28-CRP < 2.6 (remission) or DAS28-CRP ≤ 3.2 (low disease activity) ✓
- C CRP normalisation only, regardless of joint counts
- D X-ray erosion arrest at 6 months
Correct answer: B. DAS28-CRP < 2.6 (remission) or DAS28-CRP ≤ 3.2 (low disease activity)
Explanation
The treat-to-target (T2T) strategy in RA, endorsed by EULAR and ACR, aims for remission (DAS28 < 2.6) as the primary target. If remission cannot be achieved, low disease activity (DAS28 ≤ 3.2) is an acceptable alternative target. Assessments should occur every 1–3 months and treatment escalated if the target is not met. VAS pain alone and CRP normalisation are insufficient composite measures.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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