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The Finnish data presented by Drs Klaukka and Kaarela, which confirm the trend that we saw in our patient populations1 as well as in the survey of rheumatologists,2 are highly appreciated. They clearly show how drastically the use of disease modifying antirheumatic drugs (DMARDs) has changed over the past decade. Importantly, not only has the type of DMARDs employed most frequently undergone a change, but it appears from the table presented that the frequency of combination therapies may be quite high and that more patients receive DMARD treatment than even a few years ago. Such rapid changes are well in line with the observation we made in our matched surveys. There is another noteworthy aspect, which presumably also applies to the Finnish cohort: in our patients, median methotrexate doses increased from 10 mg (quartiles 7.5; 12.5 mg) in 1995 to 15 mg (10; 20 mg) in 2001, another indication that rheumatologists may be treating patients with rheumatoid arthritis (RA) much more efficiently today than less than a decade ago. This evolution is also supported by the effects of earlier DMARD use, as is also evident from our report.2
Together with the new DMARDs, such as leflunomide, we have the tumour necrosis factor α and interleukin 1 blockers, whose appropriate dosing we also will have to learn over time. With more agents to come in the near future, we may soon be able to treat patients with RA in a way that previously we could only dream about.
We would like to acknowledge that the reported work was performed in collaboration with the Ludwig Boltzmann Institute of Rheumatology and supported by a grant from the City of Vienna.
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