Recent Onset Rheumatoid Arthritis: Treatment Strategies
Recent Onset Rheumatoid Arthritis: Treatment Strategies
Purpose of review Treatment of rheumatoid arthritis (RA) requires strategies for treatment timing and treatment choices. To help rheumatologists choose the right treatment at the right time, this review describes recent trial outcomes, and studies into possible predictors for treatment strategy outcomes.
Recent findings Very early treatment with abatacept was clinically effective, but prevention of RA or remission induction has not been achieved. In general, patients with recent onset RA have earlier clinical improvement when treated with initial combination therapy with prednisone or a tumor necrosis factor inhibitor than when treated with initial monotherapy. Recent studies present data on patient-reported outcomes and show that the benefit of suppression of joint damage progression is maintained over time. For individual patients initial monotherapy may be sufficient. Biomarkers for response to treatment are promising, but are not ready for use in daily practice. A recently developed prediction model based on simple clinical predictors may be more useful to avoid overtreatment and undertreatment.
Summary Risk estimation, for instance using a prediction model, may help to decide whether patients with recent onset RA should start with monotherapy or combination therapy. Early treatment is important, but permanent remission induction is still a future target.
Treatment strategies are on the mind of every physician treating a patient with an illness more prolonged or complicated than an acute event requiring a single intervention to heal. 'When do I start which treatment? How will I proceed if this treatment fails or is not tolerated? Is it better to increase the dose or to change the drug? Shall I risk relapse by tapering and discontinuing the treatment?'
Given the many treatment options that currently exist for patients with rheumatoid arthritis, rheumatologists are looking for treatment strategy trials to provide answers to the practical questions they face in daily practice. This review will discuss the most recent trial results on strategies for timing of treatment start, strategies that compare different initial therapeutic approaches, and studies into possible predictors for strategy outcomes.
Abstract and Introduction
Abstract
Purpose of review Treatment of rheumatoid arthritis (RA) requires strategies for treatment timing and treatment choices. To help rheumatologists choose the right treatment at the right time, this review describes recent trial outcomes, and studies into possible predictors for treatment strategy outcomes.
Recent findings Very early treatment with abatacept was clinically effective, but prevention of RA or remission induction has not been achieved. In general, patients with recent onset RA have earlier clinical improvement when treated with initial combination therapy with prednisone or a tumor necrosis factor inhibitor than when treated with initial monotherapy. Recent studies present data on patient-reported outcomes and show that the benefit of suppression of joint damage progression is maintained over time. For individual patients initial monotherapy may be sufficient. Biomarkers for response to treatment are promising, but are not ready for use in daily practice. A recently developed prediction model based on simple clinical predictors may be more useful to avoid overtreatment and undertreatment.
Summary Risk estimation, for instance using a prediction model, may help to decide whether patients with recent onset RA should start with monotherapy or combination therapy. Early treatment is important, but permanent remission induction is still a future target.
Introduction
Treatment strategies are on the mind of every physician treating a patient with an illness more prolonged or complicated than an acute event requiring a single intervention to heal. 'When do I start which treatment? How will I proceed if this treatment fails or is not tolerated? Is it better to increase the dose or to change the drug? Shall I risk relapse by tapering and discontinuing the treatment?'
Given the many treatment options that currently exist for patients with rheumatoid arthritis, rheumatologists are looking for treatment strategy trials to provide answers to the practical questions they face in daily practice. This review will discuss the most recent trial results on strategies for timing of treatment start, strategies that compare different initial therapeutic approaches, and studies into possible predictors for strategy outcomes.
Source...