The inflammation of rheumatoid arthritis can cause permanent joint damage and disability. A review by Dr. Ferdinand C. Breedveld and Dr. Bernard Combe of Leiden University Medical Center in The Netherlands recommends more intensive, combination therapy early in the course of the disease.
Based on clinical trials, Breedveld and Combe concluded, “a window of opportunity may exist whereby therapeutic intervention could have a disproportionate impact on outcome, resulting in remission induction and maintenance of response after cessation of treatment.”
Currently no treatment is considered a cure for rheumatoid arthritis, but drug-free remission is an ideal outcome. The first step, according to Breedveld and Combe, is to identify which patients have rapidly progressing disease.
For these patients, drug-free remission may be more readily achieved with early combination therapy. A biologic TNF(tumor necrosis factor) inhibitor plus a disease modifying anti-rheumatic drug (DMARD), usually methotrexate, may be beneficial.