What is treat to target, and what does it mean for your appointments?
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Treat to target means you and your rheumatologist agree a measurable goal for your disease activity, check it on a schedule, and change the treatment if you are not reaching it. The goal is usually remission, or low disease activity in long-standing disease (international task force, 2010).
For rheumatoid arthritis (RA), the 2025 recommendations from the European Alliance of Associations for Rheumatology (EULAR) add a clock: a check every one to three months while the disease is active, and a change of treatment if there is no improvement by three months or the target is not reached by six (RheumNow).
AiArthritis is led by people living with autoimmune and autoinflammatory arthritis (AiArthritis) diseases. Co-hosts of the AiArthritis 360° Podcast talk through their own treatment goals in the two episodes this post draws on.
Part of Living with disease Treatment Rheumatoid arthritis
Treat to target at a glance
- Treat to target sets a measured goal for disease activity, usually remission or low disease activity, and changes the treatment until the goal is reached.
- For RA, the 2025 EULAR recommendations call for a check every one to three months while the disease is active, and a change of treatment if the target is not reached by six months.
- The score recorded at an appointment can disagree with how a patient rates their own disease (Gavigan and colleagues, 2020).
- Treatment for RA is meant to rest on a shared decision between patient and rheumatologist, so what you want treatment to give back belongs in setting the target (international task force, 2010).
What was your treatment goal conversation like?
Maybe nobody asked what you wanted from treatment, or maybe they did and the target surprised you. Others can learn from what you've been through and what helped, and we look across shared experiences to identify common challenges that guide the resources, programs, and tools we develop with patients.
How does treat to target work?
It runs as a loop rather than a list with an end, and it repeats until the target is reached.
Agree a target
A measurable level of disease activity, decided between you and your rheumatologist. It is usually remission, or low disease activity.
Measure it on a schedule
A score that includes a joint exam, recorded at your visits. In active RA, EULAR recommends a check every one to three months.
Change the plan if it is not working
A different medicine, dose, or class of treatment, when there is no improvement by three months or the target is not met by six.
Space the checks out once it holds
Once the target is sustained, the task force suggests checks every three to six months.
How quickly is the treatment supposed to change?
The 2025 EULAR recommendations for RA set this pace (RheumNow), and the 2010 task force added when checks can space out.
Between checks
While the disease is active.
Improvement due
If there is none, the treatment changes.
Target due
If it is not reached, the treatment changes.
Once it holds
How far apart checks can move.
Write down your number
Ask which score is being used, what number counts as the target, and what yours was today. A few visits of numbers show which way it is moving.
What goes into the score your rheumatologist records?
It is built from several measures, and a joint exam is one of them (international task force, 2010).
Some scores, such as the Clinical Disease Activity Index (CDAI), are worked out by your rheumatologist, and some, such as Routine Assessment of Patient Index Data 3 (RAPID3), are questionnaires you fill in yourself (Gavigan and colleagues, 2020).
Tender joints
Counted during the exam, joint by joint.
Swollen joints
Counted the same way, at the same visit.
Blood markers
Part of some scores, as a measure of inflammation.
Your own rating
How you say your disease is doing overall.
What do people describe about getting a treatment and keeping it?
People in this community describe treatment as a sequence rather than one decision.
Medicines that work, then stop working
In these accounts one treatment gives way to the next. One person counted seven biologics before finding one that held.
Coverage rules that decide what comes next
Which medicine can be tried next is often set by the rules behind someone's coverage as much as by the clinic.
A good stretch that is not the same as over
Months of feeling well can end without warning, so a good stretch is not the same as the disease being over.
Drawn from what people living with, or alongside, these diseases have written to AiArthritis, as they described it.
What if the score and how you feel don't match?
The score is what gets written down, and it can land somewhere different from your own account. A 2018 review cites a study in which nearly 36% of patients disagreed with their rheumatologist about how active their disease was (Rheumatology International, 2018).
What patients name first
People with RA count control of pain and fatigue, and keeping physical function and quality of life, among what matters most (Rheumatology International, 2018).
Bring your own list
Write down what you want treatment to give back before you go in. A short list is harder to lose track of in a short appointment.
Ask whether it is counted
Ask whether what you came in to fix is part of the score being used, and say so if it is not.
Six, every time
In Episode 42 of the podcast, co-host Rick Phillips, who lives with rheumatoid arthritis and ankylosing spondylitis, explains why he gives the same pain score at every visit: he cannot say what separates a six from a seven.
What's worth asking at the appointment where the target is set?
The target is meant to be decided with you, and these questions give you something to bring to that conversation.
Which score are we using?
And what number counts as reaching the target.
What was my number today?
So you can see which way it moves next time.
Is what I came in to fix part of it?
Pain, fatigue, or being able to work may not show up in the number.
What are we aiming for by three months, and by six?
So you both know what a change of plan is measured against.
Is treat to target different for a child?
In Episode 38 of the podcast, co-host Deb Constien shares what sessions at the EULAR 2020 congress raised about treat to target in juvenile idiopathic arthritis (JIA).
Measuring it
A very young child may not be able to describe pain or say which joint hurts, so doctors rely more on what a parent reports and on the exam.
Remission means more
For a child, remission is defined more strictly, as no actively inflamed joints, where adult criteria can leave room for some low-level activity.
Worth asking
Which definition of remission is being used, and what the rheumatologist relies on when your child cannot describe it.
What else do people ask about treat to target?
What is the difference between remission and low disease activity?
Both are bands on the score your rheumatologist uses, and remission is the lowest one. The international task force named remission as the primary target for RA, and low disease activity as an acceptable alternative, particularly in long-standing disease (2010). Ask which band your own target sits in.
Does treat to target apply to diseases other than rheumatoid arthritis?
It was written for RA and has been carried into other diseases. The 2023 EULAR recommendations for psoriatic arthritis aim at remission or low disease activity, with at least a 50% fall in disease activity within three months and the target within six (EULAR, 2023).
Does reaching the target mean coming off medication?
Not on its own. Treat to target describes how a goal is set and how often treatment changes to reach it, and once the target holds, checks can space out to every three to six months (task force, 2010). Anything beyond that is a decision you make with your rheumatologist.
What does treat to target ask of me?
More appointments, blood tests, and questionnaires while the disease is active, and those take time and money. Changing a treatment can be its own hurdle when the current one is working well enough. That is part of why treatment for RA is meant to rest on a shared decision (task force, 2010).
What if insurance refuses the treatment chosen to reach the target?
That is usually step therapy or prior authorization, a process separate from the clinical decision, with its own rules for appealing. Both are taught in our Knowledge = Empowerment classroom, in peer-led classes taught by patients, on how the rules behind your coverage work.
What did the target conversation leave out for you?
Write it, or record it as a voice message or a short video of up to five minutes.
One experience can be a powerful example. Many experiences together can drive change.
Join AiArthritis Voices
Taking part doesn't stop at one experience. Through AiArthritis
Voices, patients get invited to share experiences, take a quick survey or poll, join a discussion, help explore an issue, advise on or co-create a solution, evaluate what has been built, and serve on an advisory panel.
Some of the panels we can connect you to are paid.
Where can you go from here?
Early treatment for rheumatoid arthritis
A debrief of the EULAR 2025 debate on early treatment for people at high risk of RA.
Read it
Treat 2 Target Today with Complex Diseases (Ep 42)
Two co-hosts living with spondyloarthritis ask whether treat to target holds up in complex disease.
Listen to it
Knowledge = Empowerment classroom
Peer-led classes on step therapy, prior authorization, and the other rules behind your coverage.
Take a classResources on remission
Our resources on remission in AiArthritis diseases, and on working toward it.
Read the pageTreatment options
What treatment for AiArthritis diseases aims to do, and where treat to target fits.
Read the pageWritten from published research, from Episodes 38 and 42 of the AiArthritis 360° Podcast, and from experiences shared with AiArthritis.
Sources
- International task force. Treating rheumatoid arthritis to target: recommendations of an international task force. Annals of the Rheumatic Diseases, 2010
- RheumNow. 2025 update of the EULAR recommendations for rheumatoid arthritis management
- EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2023 update. Annals of the Rheumatic Diseases
- Gavigan K and colleagues. Barriers to treatment optimization and achievement of patients’ goals: perspectives from people living with rheumatoid arthritis enrolled in the ArthritisPower registry. Arthritis Research & Therapy, 2020
- Call for action: how to improve use of patient-reported outcomes to guide clinical decision making in rheumatoid arthritis. Rheumatology International, 2018
- AiArthritis 360° Podcast. Patient-Led Research Review from EULAR 2020 (Ep 38)
- AiArthritis 360° Podcast. Treat 2 Target Today with Complex Diseases (Ep 42)
This post is here to help you prepare. Treatment decisions are made with your rheumatologist, who can look at your whole history.