Q J Med 2000; 93: 757-760
© 2000 Association of Physicians
Commentary papers |
A new era in rheumatoid arthritis treatment—time to introduce a modified treatment pyramid
From the Department of Medicine, Kaplan Medical Center, Rehovot, and the Hebrew University-Hadassah Medical School, Jerusalem, Israel
The traditional stepped-up therapy in rheumatoid arthritis (RA)—prescribing non-steroidal anti-inflammatory drugs (NSAIDs) for a long time and only eventually adding a second-line agent (the so-called ‘pyramid’) has long been abandoned, and for very good reasons. Several important insights have been gained in recent years which have led to an entirely different approach to RA treatment. First, long-term studies of the natural history and outcomes of large cohorts of RA patients have revealed that RA is not the benign disease it was once considered to be. Rather, it is often an aggressive, relentless disease culminating in substantial disability and premature mortality in as many as 50% of the patients at 20 years from diagnosis, with only about 1 in 5 patients leading a normal life.1,2 Second, sequential sensitive imaging studies revealed that significant joint damage occurs early in most patients, often within the first year or two of synovitis, and once
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