Improving the routine management of rheumatoid arthritis: the value of tight control.

Evidence is mounting that adopting a tight control approach to the management of patients with rheumatoid arthritis (RA) yields superior clinical outcomes including inhibition of progressive structural damage. While this approach has been successfully implemented in other chronic diseases, such as diabetes, its use in RA is less straightforward as there is not a simple "gold standard" measure for disease activity. A key component of the tight control approach is the availability of easily implemented and clinically relevant assessment measures of disease activity that allow physicians to monitor progress toward preset goals. This article summarizes the evidence from clinical trials demonstrating the benefits of achieving tight control and surveys the instruments available to assess patient progress in a consistent manner. A case study clearly demonstrates the benefits of the tight control approach in routine clinical practice.