Evidence for early disease-modifying drugs in rheumatoid arthritis |
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Authors: | Email author" target="_blank">David?L?ScottEmail author |
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Institution: | (1) Department of Rheumatology, Kings College Hospital, London, UK |
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Abstract: | Some research evidence supports early aggressive treatment of rheumatoid arthritis (RA) using combination therapy with two
or more disease modifying anti-rheumatic drugs (DMARDs) plus steroids, or even DMARDs plus an anti-TNF. By contrast, conservatively
delayed DMARD monotherapy, given after non-steroidal anti-inflammatory drugs have failed, has been criticised. However, recent
long-term studies highlight the complexities in evaluating whether to abandon pyramidal treatment in favour of early DMARDs.
Although patients given early DMARD therapy show short-term benefits, longer-term results show no prolonged clinical advantages
from early DMARDs. By 5 years patients receiving early DMARDs had similar disease activity and comparable health assessment
questionnaire scores to patients who received DMARDs later in their disease course. X-ray progression was persistent and virtually
identical in both groups. These negative findings do not invalidate the case for early DMARD therapy, as it is gives sustained
reductions in disease activity in the early years of treatment without excessive risks from adverse effects. However, early
DMARDs alone do not adequately control RA in the longer term. This may require starting with very aggressive therapy or treating
patients more aggressively after early DMARD therapy has been initiated. |
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