REVIEW - Innovative treatment strategies for patients with RA

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Curr Opin Rheumatol. 2008 May;20(3):287-94.

Innovative treatment strategies for patients with rheumatoid arthritis.

van der Kooij SM, Allaart CF, Dijkmans BA, Breedveld FC.

Leiden University Medical Center, Leiden, The Netherlands.

PURPOSE OF REVIEW: The present review provides an update on novel

treatment strategies striving for remission in patients with recent

onset of rheumatoid arthritis.

RECENT FINDINGS: As early treatment is crucial to achieve optimal

results, identifying patients with rheumatoid arthritis early is

imperative to achieve clinical remission. Patients with early

arthritis who will progress to rheumatoid arthritis can be identified,

and treating these patients can postpone the diagnosis of rheumatoid

arthritis and retard the progression of structural damage. The best

way to achieve remission is by adjusting treatments at regular

intervals using predetermined response criteria. Specific treatments

to rapidly induce remission include disease modifying antirheumatic

drugs combinations, especially combined with glucocorticoids or tumor

necrosis factor antagonists. The prediction of joint damage

progression, or the response to specific drugs is not yet accurately

possible. The early institution of tumor necrosis factor antagonists

followed by discontinuation leads to sustained clinical benefit.

SUMMARY: Early treatment of patients with rheumatoid arthritis with

strategies aiming at remission results in the best outcomes. Until the

prediction of a severe disease course and treatment response becomes

possible, a promising strategy would be to rapidly induce remission

using an effective combination of drugs followed by tapering and

discontinuation. Tumor necrosis factor antagonists have proven to be

highly effective in this approach.

PMID: 18388520

http://www.ncbi.nlm.nih.gov/pubmed/18388520

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