Skip to main content

Advertisement

SpringerLink
Log in

Treatment Strategies in Early Rheumatoid Arthritis and Prevention of Rheumatoid Arthritis

  • RHEUMATOID ARTHRITIS (LW MORELAND, SECTION EDITOR)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Data now suggest that current strategies in the treatment of rheumatoid arthritis (RA) should focus on early identification and diagnosis, followed by early initiation of DMARD therapy. Initiation of treatment in early RA—ideally, less than 3–6 months after symptom onset—improves the success of achieving disease remission and reduces joint damage and disability. While the optimal treatment regimen in early RA is unclear, use of initial DMARD mono- or combination therapy with prompt escalation to achieve low disease activity or remission is an appropriate approach. Ultimately, the goal of RA management should be the prevention of inflammatory joint disease and, thereby, prevention of disability. To date, studies have shown that pharmacologic interventions can delay progression from undifferentiated inflammatory arthritis to classifiable RA. However, further investigation is needed to identify asymptomatic individuals at high risk for future RA and to intervene early enough in the pathogenesis of RA to prevent progression to clinical disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. van der Helm-van Mil AH, le Cessie S, van Dongen H, Breedveld FC, Toes RE, Huizinga TW. A prediction rule for disease outcome in patients with recent-onset undifferentiated arthritis: how to guide individual treatment decisions. Arthritis Rheum. 2007;56:433–40.

    Article  PubMed  Google Scholar 

  2. Aletaha D, Eberl G, Nell VP, Machold KP, Smolen JS. Attitudes to early rheumatoid arthritis: changing patterns: results of a survey. Ann Rheum Dis. 2004;63:1269–75.

    Article  PubMed  CAS  Google Scholar 

  3. • Singh JA, Furst DE, Bharat A, et al. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res. 2012;64:625–39. This article provides an expert opinion based on a literature review regarding the management of RA.

    Article  CAS  Google Scholar 

  4. Hernandez-Garcia C, Vargas E, Abasolo L, et al. Lag time between onset of symptoms and access to rheumatology care and DMARD therapy in a cohort of patients with rheumatoid arthritis. J Rheumatol. 2000;27:2323–8.

    PubMed  CAS  Google Scholar 

  5. Amjadi S, Khanna D, Park GS, Bulpitt KJ, Wong WK, Paulus HE. Dating the "window of therapeutic opportunity" in early rheumatoid arthritis: accuracy of patient recall of arthritis symptom onset. J Rheumatol. 2004;31:1686–92.

    PubMed  Google Scholar 

  6. Aletaha D, Breedveld FC, Smolen JS. The need for new classification criteria for rheumatoid arthritis. Arthritis Rheum. 2005;52:3333–6.

    Article  PubMed  Google Scholar 

  7. Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31:315–24.

    Article  PubMed  CAS  Google Scholar 

  8. Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62:2569–81.

    Article  PubMed  Google Scholar 

  9. Zeidler H. The need to better classify and diagnose early and very early rheumatoid arthritis. J Rheumatol. 2012;39:212–7.

    Article  PubMed  Google Scholar 

  10. •• Cader MZ, Filer A, Hazlehurst J, de Pablo P, Buckley CD, Raza K. Performance of the 2010 ACR/EULAR criteria for rheumatoid arthritis: comparison with 1987 ACR criteria in a very early synovitis cohort. Ann Rheum Dis. 2011;70:949–55. This retrospective study reports that, in comparison with the 1987 ACR RA criteria, the 2010 ACR/EULAR criteria for RA classifies more patients with early synovitis as having RA; however, the 2010 criteria may also identify subjects as having RA that will have spontaneous disease remission or who will ultimately have an alternative arthritis diagnosis.

    Article  PubMed  Google Scholar 

  11. van der Linden MP, Knevel R, Huizinga TW. van der Helm-van Mil AH. Classification of rheumatoid arthritis: comparison of the 1987 American College of Rheumatology criteria and the 2010 American College of Rheumatology/European League Against Rheumatism criteria. Arthritis Rheum. 2011;63:37–42.

    Article  PubMed  Google Scholar 

  12. Anderson JJ, Wells G, Verhoeven AC, Felson DT. Factors predicting response to treatment in rheumatoid arthritis: the importance of disease duration. Arthritis Rheum. 2000;43:22–9.

    Article  PubMed  CAS  Google Scholar 

  13. Cush JJ. Early rheumatoid arthritis—is there a window of opportunity? J Rheumatol Suppl. 2007;80:1–7.

    PubMed  CAS  Google Scholar 

  14. Nell VP, Machold KP, Eberl G, Stamm TA, Uffmann M, Smolen JS. Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology (Oxford). 2004;43:906–14.

    Article  CAS  Google Scholar 

  15. van der Woude D, Young A, Jayakumar K, et al. Prevalence of and predictive factors for sustained disease-modifying antirheumatic drug-free remission in rheumatoid arthritis: results from two large early arthritis cohorts. Arthritis Rheum. 2009;60:2262–71.

    Article  PubMed  Google Scholar 

  16. Smolen JS, Aletaha D, Bijlsma JW, et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010;69:631–7.

    Article  PubMed  Google Scholar 

  17. Lard LR, Visser H, Speyer I, et al. Early versus delayed treatment in patients with recent-onset rheumatoid arthritis: comparison of two cohorts who received different treatment strategies. Am J Med. 2001;111:446–51.

    Article  PubMed  CAS  Google Scholar 

  18. van der Linden MP, Boja R, Klarenbeek NB, Huizinga TW, van der Heijde DM. van der Helm-van Mil AH. Repair of joint erosions in rheumatoid arthritis: prevalence and patient characteristics in a large inception cohort. Ann Rheum Dis. 2010;69:727–9.

    Article  PubMed  Google Scholar 

  19. Mottonen T, Hannonen P, Korpela M, et al. Delay to institution of therapy and induction of remission using single-drug or combination-disease-modifying antirheumatic drug therapy in early rheumatoid arthritis. Arthritis Rheum. 2002;46:894–8.

    Article  PubMed  CAS  Google Scholar 

  20. Finckh A, Liang MH, van Herckenrode CM, de Pablo P. Long-term impact of early treatment on radiographic progression in rheumatoid arthritis: a meta-analysis. Arthritis Rheum. 2006;55:864–72.

    Article  PubMed  Google Scholar 

  21. van der Linden MP, le Cessie S, Raza K, et al. Long-term impact of delay in assessment of patients with early arthritis. Arthritis Rheum. 2010;62:3537–46.

    Article  PubMed  Google Scholar 

  22. Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Allaart CF, et al. Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): a randomized, controlled trial. Arthritis Rheum. 2008;58:S126–35.

    Article  PubMed  CAS  Google Scholar 

  23. Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Allaart CF, et al. Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): a randomized, controlled trial. Arthritis Rheum. 2005;52:3381–90.

    Article  PubMed  CAS  Google Scholar 

  24. Emery P, Kvien TK, Combe B, et al. Combination etanercept and methotrexate provides better disease control in very early (<=4 months) versus early rheumatoid arthritis (>4 months and <2 years): post hoc analyses from the COMET study. Ann Rheum Dis. 2012.

  25. Mottonen T, Hannonen P, Leirisalo-Repo M, et al. Comparison of combination therapy with single-drug therapy in early rheumatoid arthritis: a randomised trial. FIN-RACo trial group. Lancet. 1999;353:1568–73.

    Article  PubMed  CAS  Google Scholar 

  26. Mottonen TT, Hannonen PJ, Boers M. Combination DMARD therapy including corticosteroids in early rheumatoid arthritis. Clin Exp Rheumatol. 1999;17:S59–65.

    PubMed  CAS  Google Scholar 

  27. Breedveld FC, Weisman MH, Kavanaugh AF, et al. The PREMIER study: a multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatment. Arthritis Rheum. 2006;54:26–37.

    Article  PubMed  CAS  Google Scholar 

  28. • Moreland LW, O'Dell JR, Paulus HE, et al. A randomized comparative effectiveness study of oral triple therapy versus etanercept plus methotrexate in early, aggressive rheumatoid arthritis. Arthritis Rheum 2012. This study suggests that ~28 % of patients with early RA may have adequate disease response to monotherapy with MTX.

  29. van Vollenhoven RF, Ernestam S, Geborek P, et al. Addition of infliximab compared with addition of sulfasalazine and hydroxychloroquine to methotrexate in patients with early rheumatoid arthritis (Swefot trial): 1-year results of a randomised trial. Lancet. 2009;374:459–66.

    Article  PubMed  Google Scholar 

  30. • Saevarsdottir S, Wallin H, Seddighzadeh M, et al. Predictors of response to methotrexate in early DMARD naive rheumatoid arthritis: results from the initial open-label phase of the SWEFOT trial. Ann Rheum Dis. 2011;70:469–75. This study suggests that ~34 % of patients with early RA (<1-year duration) may have a good response (as defined by a DAS28) to monotherapy with MTX, although a longer duration of symptoms prior to initiation of MTX resulted in decreased efficacy.

    Article  PubMed  Google Scholar 

  31. Rezaei H, Saevarsdottir S, Forslind K, et al. In early rheumatoid arthritis, patients with a good initial response to methotrexate have excellent 2-year clinical outcomes, but radiological progression is not fully prevented: data from the methotrexate responders population in the SWEFOT trial. Ann Rheum Dis. 2011.

  32. Raza K, Stack R, Kumar K, et al. Delays in assessment of patients with rheumatoid arthritis: variations across Europe. Ann Rheum Dis. 2011;70:1822–5.

    Article  PubMed  Google Scholar 

  33. Breedveld F. The value of early intervention in RA—a window of opportunity. Clin Rheumatol. 2011;30 Suppl 1:S33–9.

    Article  PubMed  Google Scholar 

  34. Ospelt C, Reedquist KA, Gay S, Tak PP. Inflammatory memories: is epigenetics the missing link to persistent stromal cell activation in rheumatoid arthritis? Autoimmun Rev. 2011;10:519–24.

    Article  PubMed  Google Scholar 

  35. Aho K, Palosuo T, Heliovaara M, Knekt P, Alha P, von Essen R. Antifilaggrin antibodies within "normal" range predict rheumatoid arthritis in a linear fashion. J Rheumatol. 2000;27:2743–6.

    PubMed  CAS  Google Scholar 

  36. Rantapaa-Dahlqvist S, de Jong BA, Berglin E, et al. Antibodies against cyclic citrullinated peptide and IgA rheumatoid factor predict the development of rheumatoid arthritis. Arthritis Rheum. 2003;48:2741–9.

    Article  PubMed  Google Scholar 

  37. Nielen MM, van Schaardenburg D, Reesink HW, et al. Specific autoantibodies precede the symptoms of rheumatoid arthritis: a study of serial measurements in blood donors. Arthritis Rheum. 2004;50:380–6.

    Article  PubMed  Google Scholar 

  38. Deane KD, Norris JM, Holers VM. Preclinical rheumatoid arthritis: identification, evaluation, and future directions for investigation. Rheum Dis Clin North Am. 2010;36:213–41.

    Article  PubMed  Google Scholar 

  39. Bos WH, Wolbink GJ, Boers M, et al. Arthritis development in patients with arthralgia is strongly associated with anti-citrullinated protein antibody status: a prospective cohort study. Ann Rheum Dis. 2010;69:490–4.

    Article  PubMed  CAS  Google Scholar 

  40. Deane KD, O'Donnell CI, Hueber W, et al. The number of elevated cytokines/chemokines in pre-clinical seropositive rheumatoid arthritis predicts time to diagnosis in an age-dependent manner. Arthritis Rheum. 2010.

  41. van Dongen H, van Aken J, Lard LR, et al. Efficacy of methotrexate treatment in patients with probable rheumatoid arthritis: a double-blind, randomized, placebo-controlled trial. Arthritis Rheum. 2007;56:1424–32.

    Article  PubMed  Google Scholar 

  42. Machold KP, Landewe R, Smolen JS, et al. The Stop Arthritis Very Early (SAVE) trial, an international multicentre, randomised, double-blind, placebo-controlled trial on glucocorticoids in very early arthritis. Ann Rheum Dis. 2010;69:495–502.

    Article  PubMed  CAS  Google Scholar 

  43. Verstappen SM, McCoy MJ, Roberts C, Dale NE, Hassell AB, Symmons DP. Beneficial effects of a 3-week course of intramuscular glucocorticoid injections in patients with very early inflammatory polyarthritis: results of the STIVEA trial. Ann Rheum Dis. 2010;69:503–9.

    Article  PubMed  CAS  Google Scholar 

  44. Bos WH, Dijkmans BA, Boers M, van de Stadt RJ, van Schaardenburg D. Effect of dexamethasone on autoantibody levels and arthritis development in patients with arthralgia: a randomised trial. Ann Rheum Dis. 2010;69:571–4.

    Article  PubMed  CAS  Google Scholar 

  45. Klareskog L, Gregersen PK, Huizinga TW. Prevention of autoimmune rheumatic disease: state of the art and future perspectives. Ann Rheum Dis. 2010;69:2062–6.

    Article  PubMed  CAS  Google Scholar 

  46. Lundberg K, Kinloch A, Fisher BA, et al. Antibodies to citrullinated alpha-enolase peptide 1 are specific for rheumatoid arthritis and cross-react with bacterial enolase. Arthritis Rheum. 2008;58:3009–19.

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Grant Funding

Dr. Demoruelle is supported by grant funding from the NIH (T32AR07534), the Artritis Foundation, and the American College of Rheumatology. Dr. Deane is supported by the NIH (U19AI50864), the American College of Rheumatology, Abbott Laboratories, Inc., and the Walter S. and Lucienne Driskill Foundation.

Author information

Authors and Affiliations

  1. Division of Rheumatology, University of Colorado School of Medicine, 1775 Aurora Court, Mail Stop B-115, Aurora, CO, 80045, USA

    M. Kristen Demoruelle & Kevin D. Deane

Authors
  1. M. Kristen Demoruelle
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kevin D. Deane
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kevin D. Deane.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Demoruelle, M.K., Deane, K.D. Treatment Strategies in Early Rheumatoid Arthritis and Prevention of Rheumatoid Arthritis. Curr Rheumatol Rep 14, 472–480 (2012). https://doi.org/10.1007/s11926-012-0275-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11926-012-0275-1

Keywords

Search

Navigation