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[Pharmacotherapy of patients with (early) rheumatoid arthritis]
J W Jacobs1, A A Blaauw, B A Dijkmans
1Universitair Medisch Centrum, afd. Reumatologie en Klinische Immunologie, Utrecht.
Abstract:
As soon as the diagnosis 'early rheumatoid arthritis (RA)' is made, a disease-modifying antirheumatic drug (DMARD) should be prescribed without delay. Methotrexate in dosages up to 30 mg once weekly is being used more frequently than in the past, also in early RA. Combination therapy with DMARDs is indicated in case of insufficient effect of a single DMARD. Combinations with methotrexate appear to be especially effective, like methotrexate and cyclosporin. A novel effective DMARD is leflunomide. In the near future promising biologicals will probably be applied in clinical daily practice, presumably in combination with conventional DMARDs. New non-steroidal anti-inflammatory drugs (NSAIDs) have been developed that are probably safer than conventional NSAIDs. If the recent finding that glucocorticoids are able to inhibit joint damage in (early) RA will be confirmed, prednisone might be used more often in (early) RA. Bone marrow transplantation in RA is still experimental.
Insights
Early rheumatoid arthritis (RA) requires prompt treatment with disease-modifying antirheumatic drugs (DMARDs). Effective options include methotrexate, combination therapies, leflunomide, and potentially biologics and safer NSAIDs.
Area of Science:
- Rheumatology
- Pharmacology
Context:
- Early rheumatoid arthritis (RA) diagnosis necessitates immediate initiation of disease-modifying antirheumatic drug (DMARD) therapy.
- Methotrexate is increasingly utilized for early RA, with dosages up to 30 mg weekly.
- Combination DMARD therapy is recommended when monotherapy proves insufficient.
Purpose:
- To outline current and emerging treatment strategies for early rheumatoid arthritis.
- To discuss the role of various pharmacologic agents in managing early RA.
- To highlight the potential of novel therapies and combination treatments.
Summary:
- Prompt initiation of DMARDs is crucial for early RA management.
- Methotrexate is a frequently used agent, with combination therapies showing particular efficacy.
- Newer agents like leflunomide, biologics, safer NSAIDs, and potentially glucocorticoids like prednisone offer future treatment avenues.
- Bone marrow transplantation remains an experimental approach for RA.
Impact:
- Provides a concise overview of evidence-based and emerging treatments for early RA.
- Informs clinicians about the expanding therapeutic landscape for rheumatoid arthritis.
- Highlights the importance of timely and tailored pharmacologic interventions in early RA.