REVIEW - The value of early intervention in RA - a window of opportunity

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Clin Rheumatol. 2011 Mar;30 Suppl 1:S33-9. Epub 2011 Feb 25.

The value of early intervention in RA--a window of opportunity.

Breedveld F.

Department of Rheumatology, Leiden University Medical Center, C4R, PO

Box 9600, 2300RC Leiden, The Netherlands.

Abstract

Rheumatoid arthritis (RA) is associated with progressive joint

destruction, with functional status influenced by both disease

activity and radiographic progression.

The case for early aggressive treatment of RA is based on large

amounts of good data in many countries. Studies with conventional

disease-modifying anti-rheumatic drugs in early RA have shown improved

outcomes compared with later treatment, especially if an aggressive

approach with combinations of drugs is used. Early intervention with

tumour necrosis factor (TNF) inhibitors has been shown to improve

clinical outcomes, induce remission and prevent radiographic

progression. It also improves patients' functional status,

health-related quality of life, and reduces fatigue.

Patients with RA have reduced productivity, an increased number of

lost work days and retire early; enabling patients to work should be

at the core of a therapy's cost-effectiveness. Introduction of

anti-TNF therapy early in RA has been shown to decrease job loss and

reduce the amount of working time missed. Although the drug costs of

initial treatment with combination therapy including a TNF inhibitor

are high, these may be compensated by the reduction in lost

productivity, making such a strategy cost-effective overall. In

addition, some patients who respond well to combination therapy may be

able to stop the TNF inhibitor.

It is important to assess the benefits of any intervention not just to

healthcare costs but to society as a whole, and physicians should be

advocates for optimal access to effective therapies for their

patients.

PMID: 2135079

http://www.ncbi.nlm.nih.gov/pubmed/21350796

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