Management of rheumatoid arthritis

• Autores: Rozeena Garner, Tina Ding, Chris Deighton
• Localización: Medicine, ISSN-e 1357-3039, Vol. 42, Nº. 5, 2014, págs. 237-242
• Idioma: inglés
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• Resumen

  • The management of rheumatoid arthritis (RA) has changed substantially over recent years. The emphases are now on early recognition of persistent synovitis in primary care, rapid referral to specialist services and prompt use of disease-modifying anti-rheumatic drugs (DMARDs). For patients with newly diagnosed active RA, a combination of DMARDs should be offered as first-line treatment as soon as possible. Corticosteroids are often administered in early disease, but their use is not a good long-term strategy for most patients. A multidisciplinary approach is important, and patient education is essential. Tumour necrosis factor-α inhibitors and other biological drugs have had a big impact on the management of RA not responding to conventional DMARDs, but in the UK their use has been restricted by cost to patients with ongoing active disease who have failed to respond to two DMARDs. It is sometimes possible to reduce therapy in patients who are doing well, but whether DMARDs can be safely stopped in all patients in remission is contentious. In the future there will be improvements in early diagnosis and better prognostic markers, and health economic arguments will extend eligibility for biologic drugs so that pharmacological strategies will make remission the rule and not the exception.