Treatment of early-stage rheumatoid arthritis

Treatment of early-stage rheumatoid arthritis

Rheumatoid arthritis (RA) is the most common inflammatory form of arthritis, affecting approximately two million Americans. It is a systemic autoimmune disease for which there is no known cure.

Several data have shown that joint damage in RA can occur as early as 4 months after symptoms begin. And further evidence has shown that early intervention with the disease using disease-modifying anti-rheumatic drugs (DMARDs) improves the signs and symptoms of the disease but also slows the rate of radiographic progression, a primary determinant of future disability. Because it is a systemic disease, joint damage can also be accompanied by significant damage to other organ systems such as the lungs, eyes, bone marrow, skin and nerves.

Guidelines from the American College of Rheumatology have suggested that DMARD therapy be initiated immediately within the first three months of diagnosis. Sometimes adding low-dose prednisone – an oral corticosteroid – can help buy time by acting as a “bridge” until the DMARD begins to work. Combining methotrexate, the “workhorse” DMARD, with low-dose prednisone can reduce disease activity, slow the rate of disease progression, and prevent further physical disability.

A word of warning is that delaying treatment for more than three months from the time of diagnosis has serious consequences, as there is a higher chance of joint damage and a lower chance of future remission. Additionally, once joint damage occurs, it cannot be reversed. So prevention is key.

Thus, a common sense paradigm has emerged for the treatment of early rheumatoid arthritis. Most rheumatologists are increasingly sticking to this model.

The first is early detection. Of course, this depends on early referral to a rheumatologist.

The second important point is the immediate initiation of DMARD treatment, preferably with methotrexate, together with low-dose prednisone.

And the final approach is to use the “treat-to-target” model that has become fashionable recently. Targeted treatment implies the need for very strict control of the disease. This approach allows the patient to have a tailored treatment program with the aim of achieving either low disease activity or complete remission. Achieving the treatment goal can be done objectively using various measurement tools, including joint counts, blood tests for inflammation, and various imaging techniques.

Such a treatment approach is not dissimilar to treatment approaches for other serious chronic diseases such as hypertension and diabetes.

Inspired by Nathan Wei