CONSENSUS STATEMENT: Contemporary treatment principles for early RA

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Rheumatology Advance Access originally published online on April 28, 2009

Rheumatology 2009 48(7):765-772; doi:10.1093/rheumatology/kep073

Contemporary treatment principles for early rheumatoid arthritis: a

consensus statement

D. W. Kiely1, K. Brown2,3, J. 4,

T. O’Reilly5, J. K. Östör6, Mark Quinn2, Allister

Taggart7, C. 8, J. Wakefield9 and Philip G.

Conaghan9

1Department of Rheumatology, St s Healthcare NHS Trust,

London,2Department of Rheumatology, York Hospitals NHS Foundation

Trust,3Department of Rheumatology, Hull & York Medical School,

University of York, York,4Department of Rheumatology, Southampton

University Hospitals NHS Trust, Southampton,5Department of

Rheumatology, West Suffolk Hospital, Bury St Edmunds,

Suffolk,6Department of Rheumatology, School of Clinical Medicine,

University of Cambridge, Addenbrooke's Hospital, Cambridge,7Department

of Rheumatology, Belfast Hospitals Trust, Belfast,8Kennedy Institute

of Rheumatology, Faculty of Medicine, Imperial College London, London

and9Section of Musculoskeletal Disease, Leeds Institute of Molecular

Medicine, University of Leeds, Leeds, UK.

Correspondence to: D. W. Kiely, Department of Rheumatology, St

s Healthcare NHS Trust, London SW17 0QT, UK.

Abstract

Objective. RA has a substantial impact on both patients and healthcare

systems. Our objective is to advance the understanding of modern

management principles in light of recent evidence concerning the

condition's diagnosis and treatment.

Methods. A group of practicing UK rheumatologists formulated

contemporary management principles and clinical practice

recommendations concerning both diagnosis and treatment. Areas of

clinical uncertainty were documented, leading to research

recommendations.

Results. A fundamental concept governing treatment of RA is

minimization of cumulative inflammation, referred to as the

inflammation–time area under the curve (AUC). To achieve this, four

core principles of management were identified:

(i) detect and refer patients early, even if the diagnosis is

uncertain: patients should be referred at the first suspicion of

persistent inflammatory polyarthritis and rheumatology departments

should provide rapid access to a diagnostic and prognostic service;

(ii) treat RA immediately: optimizing outcomes with conventional

DMARDs and biologics requires that effective treatment be started

early—ideally within 3 months of symptom onset;

(iii) tight control of inflammation in RA improves outcome: frequent

assessments and an objective protocol should be used to make treatment

changes that maintain low-disease activity/remission at an agreed

target;

(iv) consider the risk–benefit ratio and tailor treatment to each

patient: differing patient, disease and drug characteristics require

long-term monitoring of risks and benefits with adaptations of

treatments to suit individual circumstances.

Conclusion. These principles focus on effective control of the

inflammatory process in RA, but optimal uptake may require changes in

service provision to accommodate appropriate care pathways.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/48/7/765?etoc

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