Arthritis Needs Early Treatment

July 26, 2002

Waiting Even a Few Months Can Mean More Disability for Rheumatoid Variety

By Liza Jane Maltin

April 1, 2002 -- Delaying rheumatoid arthritis treatment can make a big

difference in how well the disease responds to treatment. Finnish

researchers report that early intervention -- immediately after symptoms

begin -- can send the debilitating disorder into remission. But waiting just

a few months can mean that even multiple drugs won't alleviate the joint

stiffness, swelling, and pain.

Their report appears in the April issue of Arthritis & Rheumatism.

Timo Möttönen, MD, PhD, of Turku University Central Hospital in Turku,

Finland, and colleagues looked at what happened to 178 men and women with

rheumatoid arthritis (RA) who'd begun treatment -- with either a single drug

or a combination of drugs.

Patients fell into one of four groups: those who received a single drug soon

after the onset of symptoms, those who received the single drug more than

four months after symptoms began, those who received the drug combination

right away, and those who received the combination after a four-month delay.

At the end of two years, 35% of patients in the single-drug/early-treatment

group felt better, compared with only 11% of those in the

single-drug/delayed-treatment group. Overall, those treated with the drug

combination faired better -- 42% in both the early- and delayed-treatment

groups felt better, and tests showed they had less joint damage. But they

did have to take a lot more drugs.

Once started, it is very rare for RA symptoms to spontaneously disappear, or

go into remission, the researchers write. " Accumulating evidence indicates

that the course of RA is determined early, and that the optimal [treatment]

of RA requires a swift diagnosis and immediate aggressive treatment. "

In an editorial accompanying the report, Theodore Pincus, MD, of Vanderbilt

University, and colleagues say that early care is clearly a must for people

with rheumatoid arthritis, but there is a shortage of specialists available

to treat them. " A primary reason for delay in providing rheumatologic care

is a relative shortage of rheumatologists, " they write.

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