Treatment strategies in early rheumatoid arthritis and prevention of rheumatoid arthritis

Abstract

Data now suggest that current strategies in the treatment of rheumatoid arthritis (RA) should focus on early identification and diagnosis, followed by early initiation of DMARD therapy. Initiation of treatment in early RA-ideally, less than 3-6 months after symptom onset-improves the success of achieving disease remission and reduces joint damage and disability. While the optimal treatment regimen in early RA is unclear, use of initial DMARD mono- or combination therapy with prompt escalation to achieve low disease activity or remission is an appropriate approach. Ultimately, the goal of RA management should be the prevention of inflammatory joint disease and, thereby, prevention of disability. To date, studies have shown that pharmacologic interventions can delay progression from undifferentiated inflammatory arthritis to classifiable RA. However, further investigation is needed to identify asymptomatic individuals at high risk for future RA and to intervene early enough in the pathogenesis of RA to prevent progression to clinical disease.

Fig. 1

Model of rheumatoid arthritis (RA) development and potential interventions to prevent progression of disease. In this model of RA development, disease likely begins with genetic risk and exposure to environmental risk factors (phase 1) that trigger asymptomatic inflammation and autoimmunity (phase 2). Over time, autoimmunity progresses to symptomatic inflammatory arthritis (phase 3) that may further progress to classifiable RA (phase 4). The mechanisms of transition between these phases are not well understood but likely involve complex relationships between host and environmental factors that may differ between phases. Prevention of the progression of disease may be implemented at several points along this pathway of disease development