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1

????????
????
??????????
T2T Steering Committee
??? ??? ??? ??? ???

2
Treat-to-Target (T2T)

????????????,???????
????????????????,???
?????????,???????,?
??????????
??,???????????????T2T
(Treat-to-Target) ???,T2T????????

2
3
Treat to Target
Condition Characteristics Treatment Target
Diabetes Chronic illness Poorly controlled can lead to serious complications and disability Complications often cause serious illness and premature death. lt7 HbA1c
Hypertension Chronic illness Poorly controlled can lead to serious complications and disability Complications often cause serious illness and premature death. BP 140/90 (135/80 for diabetes patients) (LDL)-cholesterol target of 70 mg/dL to decrease incidence of cardiac events
Rheumatoid Arthritis Chronic illness Poorly controlled can lead to serious complications and disability Complications often cause serious illness and premature death. Remission Low disease activity
4
????

??? HbA1c lt7
??HbA1c 7???
??????? 7???
??? ??140/90 (?????135/80),
??????(LDL) 70 mg/dL ?????????

4
5
????????????(Treat RA to Target)

??(remission)
??
??????? (LDLlow disease activity)

6
(No Transcript)
7
???????????????????????

????????????????????????
???????????????,???????????
??,?????????????????
????????,???????????????
????????????????????,??????????????????,???
??????????????????,??,?????????????

8
????????????????
9
1987????????????

??????????????????????????
?????,??????????????????????
?????,????(???????)???????????
?????????????????,?????
????????
??????(RF)
X???????????????????
???????????,????????????????

10
2010? ??????????The New ACR/EULAR RA Criteria
(2010)

????(???????)
??????????????????(????),
??????????????????
??????????????????? 6?,??????RA???
A. ??????
1 ???? 0 ?
210???? 1 ?
13???? (??????????) 2?
410???? (??????????) 3?
gt10 ?? (????1???? ) 5?
B. ???(??????????)
RF?ACPA??????? 0?
RF?ACPA?????????????,?????????3? 2?
RF?ACPA?????????????,?????????3? 3?
C. ?????? (??????????)
CRP ? ESR ?? 0?
CRP ? ESR ????? 1?
D. ???????
???? 0?

11
?????????

?????????????
???? 6???????(????)
?????????????????????? (????)
??????????
??ACPA?????????(?????RF??????)

12
????????????

??(remission)
????????????
??????? (LDLlow disease activity)
???????,????????,?????????????????

13
?????????????

??
???????
???????
???????

14
??????????

???????????????(?DAS-28?SDAI?CDAI?)???????????????
?
?????????????????????,????DAS-28?????,????????????
???????DAS-28?

15
???DAS-28?

DAS-28 ??????28????????
10????????
10??????????
?????
?????
?????
?????

16
???DAS-28?

DAS-28????????
TJC28 28????????????
SJC28 28 ????????????
ESR???????
GH (general health)????????
(???100 mm??????????????????)

17
???DAS-28?

???????,????
???(???????)
???(???????)
??????(ESR)
GH??? mm???
??????????
(TJC0.56, SJC0.28, ESR0.7, GH0.014)
??????,??????,??DAS-28???

18
DAS-28????

DAS28
0.56 v (TJC28)
0.28 v (SJC28) 0.70 Ln
(ESR)
0.014 (GH)

19
DAS-28??????????

DAS-28??????????????????
gt 5.1 ???????
3.2 5.1 ???????
2.6 3.2 ???????
lt 2.6 ??

20
DAS-28??????????
??? ?? ? ? ?
DAS28 lt 2.6 2.6-3.2 3.2-5.1 gt5.1
gt 5.1 ??????? 3.2 5.1 ??????? 2.6
3.2 ??????? lt 2.6 ??
21
DAS-28??????
?? ???,?????,RA????,?????5?????,6????????5?????
,8????????ESR??55?????????85?,?????????DAS28??

DAS28
0.56 x v (14) (??????)
0.28 x v(10) (??????)
0.70 x Ln (55) (ESR)
0.014 x (85) (GH)
6.99

Tender joint count(TJC) ?????
Swollen joint count(SJC)?????
ESR???????
Patient General Health(GH)????????

22
????

??? lt7 HbA1c
??? ??140/90 (?????135/80),
??????(LDL) 70 mg/dL ?????????
??????
????(Remission)
???????(low disease activities)

23
????????????(T2T)???????????????????T2T?????????
?????????

????????????(T2T)??20??????
??????,??????????????????,?????????????????????
????????????????60???????
????????,???T2T?4????10????
T2T???????????????????????
????????,????????????,??
???????????,??????????????

24
T2T

Chairman
J. Smolen (Austria)
Steering committee
D. Aletaha (Austria), B. Haraoui (Canada), E.
Keystone (Canada), B. Combe (France), M. Dougados
(France), G. Burmester(Germany), J. Kalden
(Germany), D. Boumpas (Greece), M. Cutolo
(Italy), C. Montecucco (Italy), T. Kvien
(Norway), J. Gomez-Reino (Spain), E. Martin-Mola
(Spain), J.W.J. Bijlsma (The Netherlands), F.
Breedveld (The Netherlands), M. de Wit (The
Netherlands), D. Van der Heijde (The
Netherlands), P. Emery (UK), I. MacInnes (UK), A.
Gibofsky (USA)
Research Fellow
M. Schoels (Austria)

25
T2T 4???
A. ???????????????????????????
B. ????????????????????, ??????, ???????????????,????????????
C. ???????????????
D. ???????????????????,????????????????
JS Smolen et al. Ann Rheum Dis, Jan 2010.
26
T2T 10???
1. ??????????????,?????????????
2. ???????????????????????????
3. ??????????????,???????????,???????????????????????,?????????????????
4. ????????????,??(???)???3?????????
5. ??????????????????????????????,??????????????????????????????????,??????(???3?6????)?
JS Smolen et al. Ann Rheum Dis, Jan 2010.
27
T2T 10???
6. ?????????,?????????????????????(????????),?????????
7. ???????,??????????????,??????????????????
8. ?????????,??????????????
9. ???????????????????????,??????????????????????????
10. ??????????????,???????????,???????????????
JS Smolen et al. Ann Rheum Dis, Jan 2010.
28
?????????????????,????????????