Measuring disease activity in inflammatory rheumatic disease and treat-to-target
What CRP and ESR actually measure, how DAS28, CDAI, SDAI, ASDAS and LLDAS are built and read, a worked DAS28 calculation, and why IL-6 blockade and lupus break the usual rules.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Treat to target (T2T) means measuring activity with a composite score at each visit and escalating treatment until a predefined target is reached. TICORA (Lancet 2004) showed monthly DAS-driven escalation gave more remissions than routine care.
- In RA the target is remission, or low disease activity in long-standing disease. EULAR 2025 (published 2026) keeps the timeline: improvement by 3 months, target by 6 months, otherwise change therapy.
- Composite scores mix joint counts, a patient-reported item and an acute-phase reactant. Knowing what each part measures explains when a score misleads.
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Sources
- Therapeutic Guidelines: RheumatologyAU/NZTherapeutic Guidelines Limited (eTG complete), current online version, accessed November 2026
- Smolen JS et al. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis 2016;75:3-15EULAR / international T2T task force, 2014 update (published 2016)
- Smolen JS et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological DMARDs: 2025 update. Ann Rheum Dis 2026;85:991-1009EULAR, 2025 (published 2026)
- Studenic P et al. American College of Rheumatology/EULAR remission criteria for rheumatoid arthritis: 2022 revision. Arthritis Rheumatol 2023;75:15-22ACR and EULAR, 2022 revision
- England BR et al. 2019 update of the American College of Rheumatology recommended rheumatoid arthritis disease activity measures. Arthritis Care Res 2019;71:1540-55American College of Rheumatology, 2019
- Machado PM et al. Ankylosing Spondylitis Disease Activity Score (ASDAS): 2018 update of the nomenclature for disease activity states. Ann Rheum Dis 2018;77:1539-40Assessment of SpondyloArthritis international Society, 2018
- Franklyn K et al. Definition and initial validation of a Lupus Low Disease Activity State (LLDAS). Ann Rheum Dis 2016;75:1615-21AU/NZAsia Pacific Lupus Collaboration, 2016
- Touma Z et al. SLEDAI-2K 10 days versus SLEDAI-2K 30 days in a longitudinal evaluation. Lupus 2011;20:67-70Lupus, 2011
- Grigor C et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. Lancet 2004;364:263-9The Lancet, 2004
- Last updated
- 14 November 2026
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