Evidence for early disease-modifying drugs in rheumatoid arthritis

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Commentary: Evidence for early disease-modifying drugs in rheumatoid

arthritis Arthritis Res Ther 2004, 6:15-18 (published 16 December 2003)

http://arthritis-research.com/content/6/1/15/abstract

Abstract

Some research evidence supports early aggressive treatment of rheumatoid

arthritis (RA) using combination therapy with two or more disease

modifying anti-rheumatic drugs (DMARDs) plus steroids, or even DMARDs

plus an anti-TNF. By contrast, conservatively delayed DMARD monotherapy,

given after non-steroidal anti-inflammatory drugs have failed, has been

criticised.

However, recent long-term studies highlight the complexities in

evaluating whether to abandon pyramidal treatment in favour of early

DMARDs. Although patients given early DMARD therapy show short-term

benefits, longer-term results show no prolonged clinical advantages from

early DMARDs.

By 5 years patients receiving early DMARDs had similar disease activity

and comparable health assessment questionnaire scores to patients who

received DMARDs later in their disease course. X-ray progression was

persistent and virtually identical in both groups.

These negative findings do not invalidate the case for early DMARD

therapy, as it is gives sustained reductions in disease activity in the

early years of treatment without excessive risks from adverse effects.

However, early DMARDs alone do not adequately control RA in the longer

term.

This may require starting with very aggressive therapy or treating

patients more aggressively after early DMARD therapy has been initiated.

L

Department of Rheumatology, Kings College Hospital, London, UK