PURPOSE OF REVIEW: To give an overview of recent strategy trials for the treatment of rheumatoid arthritis. RECENT FINDINGS: Strategy studies showed a clear benefit of dynamic result-driven treatment towards tight control of disease activity compared with 'usual care' in rheumatoid arthritis patients. In addition, treatment given after short symptom duration gives better outcomes than later initiation of treatment. In many trials, combination therapies, especially combinations with prednisolone or biologicals, were superior to monotherapies. Moreover, combination therapies were more effective if given early in the disease as compared with a delayed introduction, giving support to the window of opportunity hypothesis. In the BeSt study, initial combination therapy could be successfully discontinued in half of the patients, emphasizing that 'initial' would mean 'temporary'. Less evidence is available about initial combination in comparison with combination therapy with a shorter delay. Larger tight-controlled, goal-steered, dynamic strategy trials comparing initial combination therapy with a short-delay combination therapy will help to translate the use of initial (temporary) combination therapy into normal daily practice. SUMMARY: Treatment strategy trials have demonstrated that in the majority of patients with rheumatoid arthritis, the following approach is the most beneficial: goal-steered, dynamic treatment towards tight control of disease activity, including early introduction of (an) effective disease-modifying antirheumatic drug(s) in combination with prednisone or antitumor necrosis factor, which includes tapering of the medication if remission or low disease activity is achieved.
PURPOSE OF REVIEW: To give an overview of recent strategy trials for the treatment of rheumatoid arthritis. RECENT FINDINGS: Strategy studies showed a clear benefit of dynamic result-driven treatment towards tight control of disease activity compared with 'usual care' in rheumatoid arthritispatients. In addition, treatment given after short symptom duration gives better outcomes than later initiation of treatment. In many trials, combination therapies, especially combinations with prednisolone or biologicals, were superior to monotherapies. Moreover, combination therapies were more effective if given early in the disease as compared with a delayed introduction, giving support to the window of opportunity hypothesis. In the BeSt study, initial combination therapy could be successfully discontinued in half of the patients, emphasizing that 'initial' would mean 'temporary'. Less evidence is available about initial combination in comparison with combination therapy with a shorter delay. Larger tight-controlled, goal-steered, dynamic strategy trials comparing initial combination therapy with a short-delay combination therapy will help to translate the use of initial (temporary) combination therapy into normal daily practice. SUMMARY: Treatment strategy trials have demonstrated that in the majority of patients with rheumatoid arthritis, the following approach is the most beneficial: goal-steered, dynamic treatment towards tight control of disease activity, including early introduction of (an) effective disease-modifying antirheumatic drug(s) in combination with prednisone or antitumor necrosis factor, which includes tapering of the medication if remission or low disease activity is achieved.
Authors: Karina Rossi Bonfiglioli; Licia Maria Henrique da Mota; Ana Cristina de Medeiros Ribeiro; Adriana Maria Kakehasi; Ieda Maria Magalhães Laurindo; Rina Dalva Neubarth Giorgi; Angela Luzia Branco Pinto Duarte; Ana Paula Monteiro Gomides Reis; Mariana Peixoto Guimarães Ubirajara E Silva de Souza; Claiton Viegas Brenol; Geraldo da Rocha Castelar Pinheiro; Cleandro Pires de Albuquerque; Charlles Heldan de Moura Castro; Gustavo Luiz Behrens Pinto; Jose Fernando Verztman; Luciana Feitosa Muniz; Manoel Barros Bertolo; Maria Raquel da Costa Pinto; Paulo Louzada Júnior; Vitor Alves Cruz; Ivanio Alves Pereira; Max Vitor Carioca de Freitas; Bóris Afonso Cruz; Eduardo Paiva; Odirlei Monticielo; José Roberto Provenza; Ricardo Machado Xavier Journal: Adv Rheumatol Date: 2021-11-24
Authors: Christian A Waimann; Maria F Marengo; Sofia de Achaval; Vanessa L Cox; Araceli Garcia-Gonzalez; John D Reveille; Marsha N Richardson; Maria E Suarez-Almazor Journal: Arthritis Rheum Date: 2013-06
Authors: Jonas Bystrom; Felix I Clanchy; Taher E Taher; Mohammed M Al-Bogami; Hawzheen A Muhammad; Saba Alzabin; Pamela Mangat; Ali S Jawad; Richard O Williams; Rizgar A Mageed Journal: Clin Rev Allergy Immunol Date: 2017-10 Impact factor: 8.667
Authors: Marloes Vermeer; Hillechiena H Kuper; Hein J Bernelot Moens; Monique Hoekstra; Marcel D Posthumus; Piet L C M van Riel; Mart A F J van de Laar Journal: Arthritis Res Ther Date: 2012-11-23 Impact factor: 5.156