Rheumatoid arthritisTreatment of Early Rheumatoid Arthritis: Concepts in Management
Section snippets
Methods
We conducted a PubMed search for randomized trials using the terms “early rheumatoid arthritis” and subsequently “tight control.” References were then limited to include only randomized, controlled trials, English language articles, and human studies. Studies investigating the use of infrequently used or investigational agents were also excluded. The reference lists from the identified publications were scanned to identify further relevant studies, and additional trials were included. The
Literature Search
The PubMed search identified 148 records relevant to this review, and this was supplemented with an additional 7 records identified (Fig. 1). Sixty-six publications were excluded at the screening stage: 5 were not randomized, controlled trials; 14 included nonclinical and/or non-RA endpoints; 30 investigated infrequently used agents (azathioprine, gold, hydroxychloroquine, and penicillamine) or investigational agents; and 17 were nondrug interventions. The remaining 82 articles were obtained
Discussion
Studies on the treatment of patients with early RA have provided important information that can help guide the treatment of these patients. From the earliest studies of traditional DMARDs we learned that early initiation of therapy, particularly DMARD therapy, can lead to less radiographic progression later on in the course of the disease. As more clinical trial data accumulated, we learned that combination DMARD therapy was superior to DMARD monotherapy, and that triple DMARD therapy is even
Conclusion
In early RA, early prompt therapy with methotrexate in combination with other DMARDs or biologics leads to improved outcomes, especially when combined with a tight control strategy aimed at achieving remission or, at least, low disease activity; when the target is rapidly achieved, long-term outcomes are improved. It appears that multidrug treatment is more effective than monotherapy, and that intervening as early as possible with effective treatment yields less damage in the long term.
Acknowledgment
The authors thank Janet Manfre of inScience Communications, a Wolters Kluwer business, for editorial assistance in the preparation of this manuscript.
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Support for this manuscript was provided by Bristol-Myers Squibb Canada Co.
Dr. Haraoui has served on advisory boards for and received research grants from Abbott Laboratories, Amgen/Wyeth (Pfizer), Bristol-Myers Squibb, Roche, Schering-Plough (Merck), and UCB. Dr. Pope has consulted for or received research grants from Abbott Laboratories, Actelion, Amgen, Bristol-Myers Squibb, GlaxoSmithKline, Merck, Pfizer, Roche, Schering-Plough, UCB, United Therapeutics, and Wyeth. The agency that helped coordinate the literature search and draft of the article was commissioned by BMS Canada. The content and opinions are purely those of the authors and not of BMS.