How are these medicines typically used? Why is early treatment important? Choosing the right medication Combination therapy


HOW ARE THESE MEDICINES TYPICALLY USED?
According to the American College of Rheumatology (ACR) guidelines, "The ultimate goals in managing rheumatoid arthritis (RA) are to prevent or control joint damage, prevent loss of function, and decrease pain." To reach these goals, the ACR guidelines encourage early diagnosis of RA, patient education, and use of a variety of medicines as well as physical and occupational therapy.

WHY IS EARLY TREATMENT IMPORTANT?
Some patients with rheumatoid arthritis (RA) are more likely than others to show joint damage within the first 2 years of disease onset. Some studies have shown that patients who have active RA in multiple joints and those who show high levels of certain antibodies based on blood tests have a 70% chance of developing joint damage within this time period.

However, the use of traditional or biologic DMARDs in patients with recent-onset RA can slow or help inhibit this disease. For these reasons, early DMARD therapy is recommended for all patients with aggressive RA who have ongoing joint pain, significant morning stiffness, or fatigue despite NSAID treatment. In addition, DMARD therapy is recommended when patients have other signs of active disease or evidence of joint damage. The guidelines further recommend that patients with rheumatoid arthritis (RA) be periodically reevaluated to see how they are responding to treatment. Use of multiple medicines is also recommended for some patients.

CHOOSING THE RIGHT MEDICATION
Doctors and patients may consider many factors when selecting a medication. Some of these factors include the following:
  • How effective is it compared to other medicines?
  • How convenient is it to take?
  • What tests need to be done to monitor for side effects while using it?
  • How long does it take to begin working?
  • How frequent or serious are its side effects?

 COMBINATION THERAPY
Health care providers may prescribe one or more medicines, including analgesics, NSAIDs, DMARDs, and/or glucocorticoids for patients with rheumatoid arthritis (RA). For example, RA treatment often begins with a NSAID to reduce joint pain and swelling while improving joint function. In addition, use of glucocorticoids in low-dose oral forms or as local injections are effective for relieving the symptoms of RA. Because NSAIDs and glucocorticoids may improve symptoms without protecting against joint damage, the ACR guidelines suggest that DMARD therapy be considered for all patients with RA.

In addition, treatment with a single DMARD is not always successful; therefore, the ACR guidelines suggest that some patients may benefit from use of more than one DMARD. For example, researchers have found that patients with a partial response to Rheumatrex® (methotrexate) had improvement with the addition of an anti-TNF agent. The area of combined DMARD use continues to improve how RA is managed.

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