The treatment of newly diagnosed RA has evolved significantly over the last decade. New therapeutic modalities and strategies have emerged that have resulted in improved outcomes. Nonetheless, significant uncertainty remains about what constitutes optimal therapy, and important challenges remain:
- patients should be treated intensively as part of a treat to target strategy, but which target should be selected? Should all patients be treated to the same target irrespective of prognostic indicators?
- which DMARDs should be used, and in which combinations? Are step-up strategies as effective as other strategies?
- should biologic drugs be used routinely in early RA?
- what is the role of corticosteroids in the management of early RA?
- both musculoskeletal ultrasound and MRI are more sensitive that plain radiographs. What is the role of imaging in directing treatment in early RA?
- is stratified medicine a pipe dream, or can we expect ‘personalised’ approaches to treatment to become part of mainstream clinical practice?
An overview of the management will summarise the current evidence base with respect to these (and other) questions.
Disclosure of Interest D. Porter Grant/research support from: Research funding for TASER study from Pfizer and Roche, Consultant for: BMS, Pfizer, Medimmune, Speakers bureau: Pfizer, Roche, Abbott, BMS, UCB, MSD
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