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Response to: ’Dual target strategy: a proposal to mitigate the risk of overtreatment and enhance patient satisfaction in rheumatoid arthritis' by Ferreira et al

I thank Dr Ferreira and colleagues1 for their thoughtful response to Overdiagnosis and Overtreatment ,2 which I entirely agree with and to which I will briefly comment, since their proposal may have important clinical connotations. They argue among others that patient-reported outcomes should better be separated from objective measures for disease activity since the former do not always reflect the inflammatory process itself, a valid argument.

Our classic vision on signs and symptoms in diseases like rheumatoid arthritis (RA) has always been rather unidimensional, with which I mean that we implicitly assign most signs and symptoms reported by patients to the inflammatory (immunological) dysregulations. This has always worked well in clinical trials because patients with high levels of …