Data from several studies have indicated the need for treatment of rheumatoid arthritis (RA) as early as possible, according to a report published in The Lancet Rheumatology.1
Early arthritis treatment has been used to improve long-term outcomes and minimize structural damage resulting from both local and systemic inflammation. In addition, many researchers believe that treatment will be most effective with early intervention (eg, within 6 weeks after symptom onset).2 A recent study that included patients at risk for RA also found that multiple pathologic processes can be observed before symptoms develop, promoting the need for early intervention.3
Furthermore, data from a meta-analysis4 found that patients who consulted with a rheumatologist ≤6 weeks vs 7 to 12 weeks and >12 weeks after symptom onset were 1.7 times more likely to achieve disease-modifying antirheumatic drug (DMARD)-free remission. This trend of being less likely to achieve DMARD-free remission was observed to continue with initial visits after 12 weeks of symptom onset. Since DMARD-free remission is considered a highly desirable outcome for patients with RA, the evidence supports more aggressive treatment during early stages of the disease. Authors of this report indicated that further assessing remission data (eg, at 5 years of DMARD-free remission) could be useful in determining rates of sustained remission.
Despite these findings, there was little difference in structural damage among patients with different time to encounters, which may be at odds with the long-standing hypothesis that earlier intervention leads to minimized structural damage; however, this lack of correlation could suggest that small degrees of damage are less important for outcomes in patients who receive early treatment.
Overall, the authors of this report concluded that findings from various studies confirm the need for rapid referral and treatment of RA after symptom onset.
1. Emery P, Dequenne L. It’s never too soon to treat rheumatoid arthritis: finally, some supportive evidence [published online April 28, 2020]. Lancet Rheumatol. doi:10.1016/S2665-9913(20)30103-X
2. Combe B, Landewe R, Daien CI, Hua C, Aletaha D et al. 2016 update of the EULAR recommendations for the management of early arthritis. Ann Rheum Dis. 2017;76:948-959.
3. Nam JL, Hensor EMA, Hunt L, Conaghan PG, Wakefield RJ, Emery P. Ultrasound findings predict progression to inflammatory arthritis in anti-CCP antibody-positive patients without clinical synovitis. Ann Rheum Dis. 2016;75:2060-2067.
4. Niemantsverdriet E, Dougados M, Combe B, van der Helm-van Mil AHM. Referring early arthritis patients within 6 weeks versus 12 weeks after symptom onset: an observational cohort study [published online April 28, 2020]. Lancet Rheumatol. doi:10.1016/S2665-9913(20)30061-8