Treatment strategies in recent onset rheumatoid arthritis

Treatment of rheumatoid arthritis (RA) requires strategies for treatment timing and treatment choices. To help rheumatologists choose the right treatment at the right time, this review describes recent trial outcomes, and studies into possible predictors for treatment strategy outcomes.

Very early treatment with abatacept was clinically effective, but prevention of RA or remission induction has not been achieved. In general, patients with recent onset RA have earlier clinical improvement when treated with initial combination therapy with prednisone or a tumor necrosis factor inhibitor than when treated with initial monotherapy. Recent studies present data on patient-reported outcomes and show that the benefit of suppression of joint damage progression is maintained over time. For individual patients initial monotherapy may be sufficient. Biomarkers for response to treatment are promising, but are not ready for use in daily practice. A recently developed prediction model based on simple clinical predictors may be more useful to avoid overtreatment and undertreatment.

Risk estimation, for instance using a prediction model, may help to decide whether patients with recent onset RA should start with monotherapy or combination therapy. Early treatment is important, but permanent remission induction is still a future target.