"Fast-and-Furious", "Early-and-Aggressive", "Hit-Early-Hit-Hard": whatever pithy catchphrase you choose to call it, early treatment-to-remission forms a pillar of T2T strategy.
Achieving early disease control means faster pain relief, restoration of function, prevention of joint damage, and perhaps increase the likelihood of going off all medications eventually.
The other pillar of T2T is to achieve remission with "Whatever-It-Takes". It may not necessarily be the costly biologics or JAK inhibitors, much as the big pharmas may want to have you believe. Steroids can induce remission just as well (albeit in higher doses with the attendant side-effects), and combination csDMARDs can achieve good maintenence of remission.
With the slew of targeted therapies currently in play to treat RA, precision medicine (maximising efficacy while limiting collateral damage) is a reality in clinical practice.
The unmet need is in the dearth of biomarkers to inform the treating rheumatologist on which therapy will work best for which patient. This is the next research frontier of personalised medicine.
Once the target of sustained remission is achieved, drug-free or otherwise, the next target is RA prevention. Will it be a pre-emptive strike at preclinical disease, or a vaccination programme for at-risk individuals? Till then, it's good to dream.