Cookie policy: This site uses cookies (small files stored on your computer) to simplify and improve your experience of this website. Cookies are small text files stored on the device you are using to access this website. For more information please take a look at our terms and conditions. Some parts of the site may not work properly if you choose not to accept cookies.

Join

Subscribe or Register

Existing user? Login

Antirheumatic agents

Rheumatoid arthritis patients should be offered intensive treatment when first diagnosed

Two studies, presented at the Annual European Congress of Rheumatology, suggest it is beneficial to intensify treatment with disease-modifying anti-rheumatic drugs when patients are first diagnosed.

Evidence to support intensive treatment with disease-modifying anti-rheumatic drugs (DMARDs) when patients are first diagnosed with rheumatoid arthritis. In the image, x-ray of a patient's hand with rheumatoid arthritis

Source: BSIP SA / Alamy

A scientific meeting looks at the role of disease-modifying anti-rheumatic drugs in patients first diagnosed with rheumatoid arthritis

Evidence to support intensive treatment with disease-modifying anti-rheumatic drugs (DMARDs) when patients are first diagnosed with rheumatoid arthritis has been presented at the Annual European Congress of Rheumatology (EULAR) in Rome on 10 June 2014.

Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation in the joints. DMARDs help to prevent damage caused to patients’ bones, tendons, ligaments and cartilage when the immune system attacks the joints.

Two separate studies suggest it may be beneficial to intensify DMARD therapy when patients are first diagnosed. In the first study[1], patients recently diagnosed with rheumatoid arthritis (n=281) were given either the DMARD methotrexate alone, or methotrexate in combination with the DMARDs sulfasalazine and hydroxychloroquine. Patients’ physical mobility was measured using a health assessment questionnaire (HAQ) every three months. After two years, patients who received triple therapy were more physically mobile than patients who received methotrexate alone (median HAQ score 0.25 and 0.63, respectively; P<0.05).

“Our data showed an earlier decrease in disease severity and improvements in functional ability in the combination-therapy groups compared with monotherapy, adding to the evidence base for an intensive treatment approach early on,” says lead author Angelique Weel from the department of rheumatology, Maasstad Hospital, Netherlands.

Disease progression and severity, measured using X-rays of joints and disease activity scores, were no different between the groups. However, more patients who received methotrexate alone later required treatment with a biologic DMARD.

A second study[2] showed that patients with moderate disease may benefit from early treatment with biologic DMARDs. Such treatment may reduce the risk of serious damage to the joints, which in turn can reduce the need for surgery. The study analysed patients’ (n=2,044) treatment in the first five years after diagnosis with rheumatoid arthritis.

Patients with “low-moderate”, “high-moderate”, and “high” disease activity scores all had a large increased risk of major joint surgery (hazard ratios 2.07, 2.16 and 2.48, respectively) in the first five years after the onset of rheumatoid arthritis, indicating that patients with moderate disease may also require intense treatment to avoid damage to the joints.

“Our data provide an argument for updating existing disease activity cut-off points to allow rheumatoid arthritis patients with moderate disease activity to receive a biological agent in addition to conventional DMARDs,” says lead author Elena Nikiphorou from the rheumatology department, St Albans City Hospital, Hertfordshire.

The National Institute for Health and Care Excellence recommends that patients newly diagnosed with active rheumatoid arthritis should be offered a combination of DMARDs (including methotrexate and at least one other DMARD, plus short-term glucocorticoids) as first-line treatment as soon as possible, ideally within three months of the onset of persistent symptoms.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2015.20068729

Have your say

For commenting, please login or register as a user and agree to our Community Guidelines. You will be re-directed back to this page where you will have the ability to comment.

Recommended from Pharmaceutical Press

  • Pharmacy Registration Assessment Questions 2

    Pharmacy Registration Assessment Questions 2

    Pharmacy Registration Assessment Questions 2 features more than 400 entirely new, closed book and calculation questions. It can be used in conjunction with the previous volume or on its own. All questions are in line with current GPhC guidance, enabling you to prepare for the pharmaceutical pre-registration exam with confidence.

    £35.00Buy now
  • Remington Education: Drug Information and Literature Evaluation

    Remington Education: Drug Information and Literature Evaluation

    Remington Education: Drug Information & Literature Evaluation teaches students how to effectively and efficiently locate and analyze up-to-date drug information and literature.

    £27.00Buy now
  • English Delftware Drug Jars

    English Delftware Drug Jars

    This beautiful book illustrates the art and history of the collection of English delftware drug jars in the Museum of the Royal Pharmaceutical Society of Great Britain.

    £54.00Buy now
  • Pharmacy OSCEs

    Pharmacy OSCEs

    The only pharmacy-specific OSCE revision guide. This easy-to-use book covers the key competencies that will be tested in your exams.

    £25.00Buy now
  • Paediatric Drug Handling

    Paediatric Drug Handling

    Written for new pharmaceutical scientists, this book provides a background in paediatric pharmacy and a comprehensive introduction to children's medication.

    £33.00Buy now

Search an extensive range of the world’s most trusted resources

Powered by MedicinesComplete
  • Print
  • Share
  • Comment
  • Save
  • Print Friendly Version of this pagePrint Get a PDF version of this webpagePDF

Newsletter Sign-up

Want to keep up with the latest news, comment and CPD articles in pharmacy and science? Subscribe to our free alerts.