EDITORIAL - Comparative effectiveness of treatments for RA

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ls of Internal Medicine

EDITORIAL

Siegel, MD

15 January 2008 | Volume 148 Issue 2 | Pages 162-163

Comparative Effectiveness of Treatments for Rheumatoid Arthritis

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Rheumatoid arthritis is a chronic autoimmune disease of uncertain

cause associated with symmetric polyarthritis and, in some patients,

with extra-articular manifestations. Patients with rheumatoid

arthritis experience a chronic, fluctuating course that may result in

joint damage, disability, deformities, and even a shortened life span.

The goals of treatment are to control pain and inflammation and to

avoid, to the extent possible, progressive joint destruction.

In recent years, studies comparing immediate with delayed treatment

with disease-modifying antirheumatic drugs (DMARDs) have shown that

early treatment with these drugs is associated with improved outcomes

for signs and symptoms and slower progression of damage to joints (1).

Currently available DMARDs fall into 2 broad categories: synthetic

DMARDs, including sulfasalazine, hydroxychloroquine, methotrexate, and

leflunomide, and biological DMARDs, including tumor necrosis

factor–blocking agents, anakinra, abatacept, and rituximab.

Pharmacologic treatment for patients with rheumatoid arthritis

typically consists of synthetic DMARDs, alone or in combination, or a

biological DMARD, either alone or in combination with 1 or more

synthetic DMARDs. Biological DMARDs are not generally used in

combination with other biological DMARDs because several of these

combinations have shown increased toxicity (2, 3).

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Read the rest of the editorial here:

http://www.annals.org/cgi/content/full/148/2/162

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