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Rheumatoid Arthritis

Emerging Evidence for the Benefits of Early and Aggressive Therapy

  • Review Article
  • Interventions & Outcomes
  • Published:
Disease Management & Health Outcomes

Summary

The treatment of rheumatoid arthritis (RA) has always been a challenge. In the last 5 years, many leaders in the field have emphasised the potential of early and aggressive therapy either with single or multiple slow-acting antirheumatic drugs (SAARDs). Single agents, if given early enough, may slow the radiological progression, but many feel that combination therapy with different SAARDs and corticosteroids are more likely to achieve clinically important reduction in the progression of joint destruction and disability.

Combining drugs with different toxicities or using lower doses of toxic drugs in combination may decrease the risks associated with SAARDs while maintaining or increasing the efficacy. Few well-designed clinical trials have been undertaken to test the usefulness of combination therapy. The role and dosage of corticosteroid therapy continue to be debated.

In most parts of the world, corticosteroids have been reserved for patients with more severe disease. However, they are commonly used earlier in the US in combination with other SAARDS, especially before the patient begins a new SAARD.

This review is a qualitative overview of the literature in MEDLINE using the standardised approach recommended by the Cochrane Collaboration supplemented by contacting investigators active in the area to assess the existing evidence.

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Authors and Affiliations

  1. Department of Medicine, University of Ottawa and Ottawa General Hospital, Ottawa, Ontario, Canada

    Peter Tugwell (Chairman) & Zulma Ortiz

  2. Department of Rheumatology, University of Leeds, Leeds, England

    Bridget Griffiths

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  1. Peter Tugwell
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  2. Zulma Ortiz
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  3. Bridget Griffiths
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Correspondence to Peter Tugwell.

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Tugwell, P., Ortiz, Z. & Griffiths, B. Rheumatoid Arthritis. Dis Manage Health Outcomes 1, 141–153 (1997). https://doi.org/10.2165/00115677-199701030-00004

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