REVIEW - Early RA: strategies for prevention and management

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Best Pract Res Clin Rheumatol. 2007 Feb;21(1):27-42.

Early rheumatoid arthritis: strategies for prevention and management.

Combe B.

Immuno-Rhumatologie Hôpital Lapeyronie, CHU de Montpellier, University

Montpellier I, 371, Avenue du Doyen Gaston Giraud 34295 Montpellier

cedex 5, France.

The treatment of rheumatoid arthritis (RA) has changed considerably in

the past few years since new tools and new concepts have been

developed and validated highlighting the need for guidelines focused

on early RA. The treatment goal should now be to achieve clinical

remission, in order to prevent structural damage and long-term

disability. A very early use of effective disease-modifying

anti-rheumatic drugs (DMARDs) is a key point in patients at risk of

developing persistent and erosive arthritis. Intensive treatment such

as combination DMARDs plus steroids or biological therapies can induce

a high rate of remission, control of radiological progression and

provide better outcome than DMARD monotherapy in early RA and should

be considered in at risk patients. Regarding the risk:benefit ratio

and the cost-effectiveness of these strategies, a reasonable course of

action in early RA should be initial DMARD monotherapy such as

methotrexate. However, a close monitoring of disease activity and

radiographic progression is mandatory in order to change DMARD therapy

and strategy if necessary. Systemic glucocorticoids are effective in

the short-term relief of pain and swelling and should be considered,

but mainly as a temporary therapy part of the DMARD strategy.

Information and education for patients, as well as some

non-pharmacological interventions, can be proposed as treatment

adjuncts.

Finally, the reduction or stopping of smoking, which could prevent the

development and progression of early RA, is the only prevention tool

currently available.

PMID: 17350542

http://www.ncbi.nlm.nih.gov/pubmed/17350542

Not an MD