Treatment pathway for rheumatoid arthritis, showing obstacles and a clear destination

Unlocking Treatment Success: Overcoming Barriers in Rheumatoid Arthritis Care

Nico Varela in Health & Wellness November 2025 • 4 min read.

"Discover how to navigate patient preferences and disease activity measures for better treatment outcomes in rheumatoid arthritis."

Treat-to-target (TTT) is a strategy for managing rheumatoid arthritis (RA). This approach involves setting clear treatment goals, regularly monitoring disease activity, and making timely adjustments to medication. The aim is to achieve and maintain remission or low disease activity, improving patients' quality of life.

Despite its proven benefits, TTT isn't always implemented. This may stem from clinical inertia, workflow difficulties, or patient-specific situations. Effective TTT implementation requires a deep dive into the reasons behind non-adherence to address gaps and improve care.

A recent study investigated why treatment adjustments aren't made. The goal was to pinpoint the main barriers to TTT adherence. By examining these obstacles, healthcare providers can develop targeted strategies to optimize RA management and improve patient outcomes.

Understanding the Roadblocks: Why Treatment Adjustments Stall

Treatment pathway for rheumatoid arthritis, showing obstacles and a clear destination

The study, a secondary analysis of the TRACTION trial, examined data from patients with RA in an intervention arm. Researchers evaluated medical records to assess TTT implementation, focusing on four key components. Theses were: setting a treatment target, measuring disease activity, shared decision-making, and adjusting treatment when needed.

When treatment adjustments weren't made despite active disease, providers were asked to report the reasons. These barriers were then categorized and analyzed to identify common themes and patterns.

Patient Preferences: Many patients were reluctant to change their treatment due to concerns about side effects, costs, or a general resistance to altering their current regimen.
Disease Activity Discrepancies: Elevated disease activity scores didn't always align with clinical findings. In some cases, patients experienced pain from other conditions, which skewed the scores and made providers hesitant to escalate RA treatment.
Medication Lag Time: Sometimes, physicians delayed changes due to the time it takes for medications to take full effect.
Contraindications and Drug Side Effects: Issues such as infection, pregnancy, or side effects also played a significant role in the decision-making process.

These findings reveal the complexities of RA management and highlight the need for strategies that address both patient and provider concerns. By understanding these barriers, healthcare teams can work together to enhance TTT adherence and achieve better outcomes.

Enhancing TTT Adherence: A Path Forward

To improve TTT adherence, interventions should focus on using better markers of disease activity, improving alignment with patient preferences. Providers may find adherence to TTT more difficult with certain patients in specific clinical settings. However, our findings from the original trial suggest that TTT adherence can be improved. By addressing these challenges, we can pave the way for more effective RA management and improved patient outcomes.

About this Article -

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This article is based on research published under:

DOI-LINK: 10.1093/rheumatology/key179, Alternate LINK

Title: Barriers To Treatment Adjustment Within A Treat To Target Strategy In Rheumatoid Arthritis: A Secondary Analysis Of The Traction Trial

Subject: Pharmacology (medical)

Journal: Rheumatology

Publisher: Oxford University Press (OUP)

Authors: Agnes Zak, Cassandra Corrigan, Zhi Yu, Asaf Bitton, Liana Fraenkel, Leslie Harrold, Josef S Smolen, Daniel H Solomon

Published: 2018-07-05

Everything You Need To Know

What is treat-to-target and why is it important in rheumatoid arthritis care?

Treat-to-target is a strategy used in managing rheumatoid arthritis. It involves setting specific goals for treatment, consistently monitoring how active the disease is, and making timely changes to medication to reach and maintain remission or low disease activity. This helps improve the patient's quality of life. However, it's not always fully implemented due to issues like clinical inertia or patient-specific situations. Barriers like patient preferences and elevated disease activity scores that don't align with clinical findings can also hinder its use.

How do patient preferences affect rheumatoid arthritis treatment decisions?

Patient preferences significantly impact rheumatoid arthritis treatment. Many patients hesitate to change their treatment because of concerns about potential side effects, the cost, or simply not wanting to alter their current regimen. These preferences need to be taken into account to align treatment decisions with what patients are willing to adhere to, which is crucial for successful disease management. Ignoring these preferences can lead to non-adherence and poorer outcomes.

Why are disease activity measures so important, and what happens if there are discrepancies?

Disease activity measures play a vital role in managing rheumatoid arthritis, but discrepancies can arise. Elevated scores might not always match clinical findings, sometimes due to pain from other conditions, which can complicate treatment decisions. It's important to use better markers of disease activity that accurately reflect the patient's condition. When disease activity scores do not truly reflect the RA disease, healthcare providers can be hesitant to escalate RA treatment.

What are the most common barriers that prevent timely treatment adjustments in rheumatoid arthritis?

Barriers to treatment adjustments in rheumatoid arthritis include patient preferences, discrepancies in disease activity, medication lag time, and contraindications or drug side effects. Patients may resist changes due to concerns about side effects or costs. Elevated disease activity scores may not always align with clinical findings. Physicians might delay adjustments because medications take time to work. Issues like infection or pregnancy can also influence decisions. Addressing these barriers is essential for better treatment outcomes.

What can be done to improve adherence to treat-to-target in rheumatoid arthritis management?

Adherence to treat-to-target can be enhanced by focusing on better markers of disease activity and improving alignment with patient preferences. Providers can improve adherence to treat-to-target by addressing these challenges, which can lead to more effective RA management and improved patient outcomes. The original trial suggests that TTT adherence can be improved with the appropriate interventions.