Early Rheumatoid Arthritis: Toward Tailor-made Therapy

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Curr Rheumatol Rep. 2003 Aug;5(4):287-93.

Early rheumatoid arthritis: toward tailor-made therapy.

Landewe RB, van der Heijde DM.

Department of Internal Medicine and Rheumatology, University Hospital

Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands.

RLAN@...

Therapeutic possibilities for the treatment of early rheumatoid

arthritis (RA) have expanded largely. New treatment modalities appear very

effective with respect to relevant outcomes, such as radiographic

progression. At the same time, the costs of disease-modifying antirheumatic

drugs (DMARDs) have exponentially increased so that--given the rather high

prevalence of RA--cost may become a limiting factor in the treatment of

patients with RA. Therefore, there is a need to define the profile of those

patients that should be treated with the most effective, and, unfortunately,

the most costly, DMARDs. The authors describe herewith the heterogeneity of

RA with respect to its most important outcomes, as well as the inability to

predict those outcomes appropriately at the individual patient level. This

heterogeneity of RA is not acknowledged in the modern landmark clinical

trials that the authors base therapeutic decisions on, and the external

validity of those trials is at stake. In this article, the authors discuss

the consequences of the heterogeneity of RA in light of the perceived lack

of external validity of evidence-generating landmark trials. The authors

propose the following solutions to overcome this discrepancy: 1) earlier

recognition of RA, and 2) appropriate prediction of treatment efficacy,

because the most challenging scientific efforts may be taken in the near

future in order to arrive at a tailor-made therapy for every individual

presenting with RA.

PMID: 14531956