Historia Clínica y Consentimiento Informado en Odontología
La iniciativa T2T RiesgodeFractura.com
1. La Iniciativa T2T Principios fundamentales y recomendaciones T2T Pedro Santos Moreno Internista Reumatologo Clinica de Artritis – Hospital Militar Central Clinica Riesgo de Fractura – CAYRE IPS
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Hinweis der Redaktion
On behalf of the Treat to Target Steering Committee, I would like to cordially welcome you to the EULAR Satellite Symposium. I purposely said on behalf of the Steering Committee, while the endeavor and also the Satellite Symposium is sponsored by Abbott, and we are grateful for that support, the program has been solely developed by the T to T Steering Committee.
The objectives of the treat to target initiative was: to provide the rheumatology community with a clear Treatment Target that is applicable in daily clinical practice, and to define a clinical state or irreversible joint damage and disability is avoided, or at least it’s a goal. to achieve an international expert consensus on an appropriate Treatment Target through evidence-based medicine approaches and a Delphi-like process and to gain consensus from clinicians, patients and researchers across Europe, North and Latin American, Japan and Australia, and to disseminate to practicing rheumatologists and to patients these insights through international awareness campaigns, supporting implementation with physicians and patients by educational tools, and ultimately to transpose the results of this activity, of this initiative, into a much larger initiative that we plan on a pan-European basis for the second half of next year.
Rheumatoid arthritis is not the only the chronic, and also not the only chronic inflammatory disease. And I’ve selected here two other disorders, diabetes and hypertension or lumped together with cardiovascular diseases. And the characteristics of all these three types of chronic disorders are essentially identical. They are all chronic illnesses. If poorly controlled they can lead to serious complications and disability, and these complications often cause serious illness and premature death. When we look at diabetes and hypertension and cardiovascular disorders, our colleagues from these other specialties have defined treatment targets. For example, you and I care for patients with diabetes, probably even every day. And we know that the treatment target there is to be at a level of consolidated hemoglobin of less than seven. When we treat our patients, and they get hypercholesterolemia, then we know exactly when to start treating the patient with a lipid lowering agent and what to aim for. And we all care for patients with hypertension. Our rheumatoid arthritis patients have hypertension. And then we exactly know when to start therapy, and what blood pressure to target for. And still, for rheumatoid arthritis, we haven’t yet clearly defined, clearly defined on the basis of evidence where we should go for our patients and with our patients
Clearly, all of us know, many of us here have been involved and all of us use the agents that have led to the new era of rheumatology. We have today unprecedented outcomes, that can be achieved for our patients. Over the last decade or two, we’ve had major advances in therapies, totally novel therapies, targeted therapies have emerged and being used by all of us. We had significant advances in the way we measure all the various characteristics of the disease. In part by radiographics and functional assessment, but also, and that’s where many of the advancements have occurred, by using composite measures of disease activity that have been validated. And especially over the last few years, there has been an enhanced understanding of ‘how to approach the therapy of rheumatoid arthritis strategically’, to achieve an optimal outcome. Nevertheless, even within my own department, and definitely among the departments of my home country and across Europe, there is a heterogeneity and sometimes a wide heterogeneity of outcomes, expectations, and treatment strategies, that we apply in daily clinical practice. So what this Steering Committee was out for, was to attempt to assess the current evidence for the ability and availability to define clear outcome targets and tight disease control situations to learn if we can already integrate such targets into daily clinical practice.
I ndeed, the systematic literature review was not the first activity that we have done … Last year, at EULAR, we had performed a survey on treatment approaches and follow-up strategies in practice. Monika Schöls analyzed the survey data and submitted the paper which was published a few weeks ago, in the Annals of the Rheumatic Diseases. ( Schoels M, Aletaha D, Smolen JS, Bijlsma JW, Burmester GR, Breedveld FC, Cutolo M, Combe B, Dougados M, Emery P, Kalden J, Keystone E, Kvien TK, Martin Mola E, Montecucco C, De Wit M. Follow-up standards and treatment targets in Rheumatoid Arthritis (RA): Results of a questionnaire at the EULAR 2008. Ann Rheum Dis. 2009 Apr 22 . ) Monika Schöls then performed a systematic literature review on Targeted Treatment at the end of last year, and the steering committee formulated the initial questions, she performed the search, presented it to the Steering Committee, and finally to a larger, consensus group of experts. And that meeting happened a few weeks ago in Amsterdam.
There was a preliminary consensus framework ready in January 2009. It was prepared for amendment and discussion and voting a consensus meeting and that consensus was reached in March, by 63 experts, 5 of them patients with rheumatoid arthritis. There was a long discussion, the proposed bullet points were changed and voted on, and further refined over the last few weeks by email exchange and Paul Emery will provide you with the latest information on these bullet points.
Clearly, all of us know, many of us here have been involved and all of us use the agents that have led to the new era of rheumatology. We have today unprecedented outcomes, that can be achieved for our patients. Over the last decade or two, we’ve had major advances in therapies, totally novel therapies, targeted therapies have emerged and being used by all of us. We had significant advances in the way we measure all the various characteristics of the disease. In part by radiographics and functional assessment, but also, and that’s where many of the advancements have occurred, by using composite measures of disease activity that have been validated. And especially over the last few years, there has been an enhanced understanding of ‘how to approach the therapy of rheumatoid arthritis strategically’, to achieve an optimal outcome. Nevertheless, even within my own department, and definitely among the departments of my home country and across Europe, there is a heterogeneity and sometimes a wide heterogeneity of outcomes, expectations, and treatment strategies, that we apply in daily clinical practice. So what this Steering Committee was out for, was to attempt to assess the current evidence for the ability and availability to define clear outcome targets and tight disease control situations to learn if we can already integrate such targets into daily clinical practice.
Clearly, all of us know, many of us here have been involved and all of us use the agents that have led to the new era of rheumatology. We have today unprecedented outcomes, that can be achieved for our patients. Over the last decade or two, we’ve had major advances in therapies, totally novel therapies, targeted therapies have emerged and being used by all of us. We had significant advances in the way we measure all the various characteristics of the disease. In part by radiographics and functional assessment, but also, and that’s where many of the advancements have occurred, by using composite measures of disease activity that have been validated. And especially over the last few years, there has been an enhanced understanding of ‘how to approach the therapy of rheumatoid arthritis strategically’, to achieve an optimal outcome. Nevertheless, even within my own department, and definitely among the departments of my home country and across Europe, there is a heterogeneity and sometimes a wide heterogeneity of outcomes, expectations, and treatment strategies, that we apply in daily clinical practice. So what this Steering Committee was out for, was to attempt to assess the current evidence for the ability and availability to define clear outcome targets and tight disease control situations to learn if we can already integrate such targets into daily clinical practice.
Clearly, all of us know, many of us here have been involved and all of us use the agents that have led to the new era of rheumatology. We have today unprecedented outcomes, that can be achieved for our patients. Over the last decade or two, we’ve had major advances in therapies, totally novel therapies, targeted therapies have emerged and being used by all of us. We had significant advances in the way we measure all the various characteristics of the disease. In part by radiographics and functional assessment, but also, and that’s where many of the advancements have occurred, by using composite measures of disease activity that have been validated. And especially over the last few years, there has been an enhanced understanding of ‘how to approach the therapy of rheumatoid arthritis strategically’, to achieve an optimal outcome. Nevertheless, even within my own department, and definitely among the departments of my home country and across Europe, there is a heterogeneity and sometimes a wide heterogeneity of outcomes, expectations, and treatment strategies, that we apply in daily clinical practice. So what this Steering Committee was out for, was to attempt to assess the current evidence for the ability and availability to define clear outcome targets and tight disease control situations to learn if we can already integrate such targets into daily clinical practice.
Clearly, all of us know, many of us here have been involved and all of us use the agents that have led to the new era of rheumatology. We have today unprecedented outcomes, that can be achieved for our patients. Over the last decade or two, we’ve had major advances in therapies, totally novel therapies, targeted therapies have emerged and being used by all of us. We had significant advances in the way we measure all the various characteristics of the disease. In part by radiographics and functional assessment, but also, and that’s where many of the advancements have occurred, by using composite measures of disease activity that have been validated. And especially over the last few years, there has been an enhanced understanding of ‘how to approach the therapy of rheumatoid arthritis strategically’, to achieve an optimal outcome. Nevertheless, even within my own department, and definitely among the departments of my home country and across Europe, there is a heterogeneity and sometimes a wide heterogeneity of outcomes, expectations, and treatment strategies, that we apply in daily clinical practice. So what this Steering Committee was out for, was to attempt to assess the current evidence for the ability and availability to define clear outcome targets and tight disease control situations to learn if we can already integrate such targets into daily clinical practice.
Clearly, all of us know, many of us here have been involved and all of us use the agents that have led to the new era of rheumatology. We have today unprecedented outcomes, that can be achieved for our patients. Over the last decade or two, we’ve had major advances in therapies, totally novel therapies, targeted therapies have emerged and being used by all of us. We had significant advances in the way we measure all the various characteristics of the disease. In part by radiographics and functional assessment, but also, and that’s where many of the advancements have occurred, by using composite measures of disease activity that have been validated. And especially over the last few years, there has been an enhanced understanding of ‘how to approach the therapy of rheumatoid arthritis strategically’, to achieve an optimal outcome. Nevertheless, even within my own department, and definitely among the departments of my home country and across Europe, there is a heterogeneity and sometimes a wide heterogeneity of outcomes, expectations, and treatment strategies, that we apply in daily clinical practice. So what this Steering Committee was out for, was to attempt to assess the current evidence for the ability and availability to define clear outcome targets and tight disease control situations to learn if we can already integrate such targets into daily clinical practice.
Clearly, all of us know, many of us here have been involved and all of us use the agents that have led to the new era of rheumatology. We have today unprecedented outcomes, that can be achieved for our patients. Over the last decade or two, we’ve had major advances in therapies, totally novel therapies, targeted therapies have emerged and being used by all of us. We had significant advances in the way we measure all the various characteristics of the disease. In part by radiographics and functional assessment, but also, and that’s where many of the advancements have occurred, by using composite measures of disease activity that have been validated. And especially over the last few years, there has been an enhanced understanding of ‘how to approach the therapy of rheumatoid arthritis strategically’, to achieve an optimal outcome. Nevertheless, even within my own department, and definitely among the departments of my home country and across Europe, there is a heterogeneity and sometimes a wide heterogeneity of outcomes, expectations, and treatment strategies, that we apply in daily clinical practice. So what this Steering Committee was out for, was to attempt to assess the current evidence for the ability and availability to define clear outcome targets and tight disease control situations to learn if we can already integrate such targets into daily clinical practice.
Clearly, all of us know, many of us here have been involved and all of us use the agents that have led to the new era of rheumatology. We have today unprecedented outcomes, that can be achieved for our patients. Over the last decade or two, we’ve had major advances in therapies, totally novel therapies, targeted therapies have emerged and being used by all of us. We had significant advances in the way we measure all the various characteristics of the disease. In part by radiographics and functional assessment, but also, and that’s where many of the advancements have occurred, by using composite measures of disease activity that have been validated. And especially over the last few years, there has been an enhanced understanding of ‘how to approach the therapy of rheumatoid arthritis strategically’, to achieve an optimal outcome. Nevertheless, even within my own department, and definitely among the departments of my home country and across Europe, there is a heterogeneity and sometimes a wide heterogeneity of outcomes, expectations, and treatment strategies, that we apply in daily clinical practice. So what this Steering Committee was out for, was to attempt to assess the current evidence for the ability and availability to define clear outcome targets and tight disease control situations to learn if we can already integrate such targets into daily clinical practice.
In rheumatology we also have a number of publications indicating that targeted therapy, employing tighter disease control improves patients’ outcome. But the challenge is still to define the target that will be acceptable in daily practice, will be acceptable for all of us, and will also be implementable in daily practice. Because many things we accept, but bringing them into reality in our everyday patient care is sometimes not so easy.
The objectives of the treat to target initiative was: to provide the rheumatology community with a clear Treatment Target that is applicable in daily clinical practice, and to define a clinical state or irreversible joint damage and disability is avoided, or at least it’s a goal. to achieve an international expert consensus on an appropriate Treatment Target through evidence-based medicine approaches and a Delphi-like process and to gain consensus from clinicians, patients and researchers across Europe, North and Latin American, Japan and Australia, and to disseminate to practicing rheumatologists and to patients these insights through international awareness campaigns, supporting implementation with physicians and patients by educational tools, and ultimately to transpose the results of this activity, of this initiative, into a much larger initiative that we plan on a pan-European basis for the second half of next year.
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