Optimising the strategy of care in early rheumatoid arthritis

Dale, J. and Porter, D. (2010) Optimising the strategy of care in early rheumatoid arthritis. Best Practice and Research: Clinical Rheumatology, 24(4), pp. 443-455. (doi: 10.1016/j.berh.2009.11.009)

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Publisher's URL: http://dx.doi.org/10.1016/j.berh.2009.11.009


In rheumatoid arthritis (RA), early use of disease-modifying antirheumatic drugs (DMARDs), intensive follow-up and 'treating to target' to achieve low disease activity produce significant improvements in measures of disease activity, functional impairment and retard erosive radiographic progression. Step-up, parallel and step-down regimens are all significantly more effective than sequential monotherapy; although the most effective regimen has not been established. Minimising the period of exposure to synovitis, by including a rapidly acting agent (e.g., corticosteroids or tumour necrosis factor cc (TNF alpha) inhibitor), may slow radiographic progression further. Biologic therapies, especially TNF alpha inhibitors, are effective in early RA; however, their exact role is unclear. Current measures may overestimate the number of patients in clinical remission; therefore, musculoskeletal ultrasound and/or novel biomarkers may also have a role. Pre-clinical immunological markers could possibly be used to trigger pre-emptive treatment in asymptomatic, 'at risk' individuals. Potential treatment developments include combining biologic agents or targeting alternative immunological pathways.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Dale, Dr James and Porter, Dr Duncan
Authors: Dale, J., and Porter, D.
College/School:College of Medical Veterinary and Life Sciences > School of Infection & Immunity
Journal Name:Best Practice and Research: Clinical Rheumatology
ISSN (Online):1532-1770

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