The last two decades have seen major advances in the treatment of rheumatoid arthritis. Researchers recognize that the disease ranges from mild to severe, and the treatment should be individualized. A team in Austria collected ten clinical facts that are important for rheumatoid arthritis patients and their doctors:
1. The best way to monitor rheumatoid arthritis, in order to choose treatment options, is to use a composite index of symptoms and laboratory tests. These include swollen joint counts, tender joint counts, morning stiffness, erythrocyte sedimentation rate, and C-reactive protein in the blood.
2. Joint damage from the inflammatory process (disease activity) is the distinguishing characteristic of rheumatoid arthritis. Other forms of joint disease have similar symptoms but follow a different course. There are two types of damage that can develop separately: joint space narrowing and erosions. These can be monitored by X-ray.
3. Disability can be measured in terms of disease activity (inflammation) and joint destruction. The activity of the disease is reversible, as medication can fully stop the inflammatory process in many cases. Joint destruction, however, is irreversible.
4. The severity of the disease is highly variable from one patient to the next. Greater severity is associated with cardiovascular disease, lymphoma, and loss of ability to work.
5. The goal of therapy should be the lowest possible disease activity. Ideally, the process of inflammatory damage to the joints should be stopped to qualify for remission.
6. Early diagnosis and treatment produce much better results than delayed therapy. The destructive process begins within the first few weeks or months of rheumatoid arthritis, and most patients have permanent joint damage within two years. Unfortunately, current data for diagnosis are based on patients with long-term disease. Criteria for early diagnosis remain a research challenge.
7. Follow-up examinations should be done every tree months as long as the disease is active, and the medication should be changed after a maximum of tree to six months if it is not producing remission or at least a very low level of inflammation.
8. Remission is highly achievable with a combination of tumor necrosis factor inhibitors and methotrexate.
9. Therapy that works for the joints also prevents common complications of vascular inflammation, lymphoma, infection, and heart disease.
10. Treatment strategies should be modified to include options for biologic therapies, including tumor necrosis factor inhibitors.
Sources:
Smolen JS et al., “Developments in the clinical understanding of rheumatoid arthritis”, Arthritis Res Ther. 2009: 11(1): 204.
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.