Management of early rheumatoid arthritis

Rheumatoid arthritis is a treatable cause of disability. The benefits of disease modifying anti-rheumatic drug therapy (DMARD) have been established, and current best practice is to commence it as early as possible during the course of RA. Equally, important is to monitor treatment effects, and adjust therapy accordingly. Because remission, the current goal of management, is difficult to achieve with single DMARD therapy, there has been increased interest with early use of combination DMARD therapy as well as biological therapy. Most patients require symptom-relieving treatments as well but it is best to limit exposure to non-steroidal anti-inflammatory drugs and systemic corticosteroids to minimise cardiovascular risk. Patients also benefit from input of other members of the multidisciplinary team, and measures designed to improve cardiovascular health. Further studies would hopefully help to improve therapeutic strategies, and achieve remission and prevent disability.