Should patients with recent-onset polyarthritis receive aggressive treatment?

Abstract

The diagnostic and therapeutic management of rheumatoid arthritis has benefited considerably in recent years not only from the introduction of new treatments (including new disease-modifying antirheumatic drugs, new combinations of these drugs, and TNF inhibitors), but also from the development of new concepts. Important new concepts include the use of novel diagnostic approaches, very early management within the first 3–6 months of symptom onset, periodic assessments of clinical disease activity based on objective clinical criteria and radiographic progression, and earlier use of aggressive treatments. The goal is to induce a clinical remission, thereby preventing radiographic deterioration. These concepts are firmly supported by sound scientific data. At present, patients at risk for progression to severe rheumatoid arthritis must be identified early on, and disease activity and progression must be monitored closely. This should enable patients with highly progressive disease to receive aggressive treatment (e.g., a combination of disease-modifying antirheumatic drugs or biological therapy) very early on with the goal of minimizing joint destruction and subsequent functional impairments.