Is Early, Aggressive Treatment Best for All Rheumatoid Arthritis Patients?

Preventing Joint Damage Is the Goal of Treatment

Many years ago, a conservative treatment approach for rheumatoid arthritis (RA) was the norm. Over the years, however, the approach has swung from conservative to early and aggressive as doctors have learned that the earlier you get treatment, the better off you'll be in the long run. This altered approach has improved the outcomes and life expectancies of people with this disease. In fact, studies show that modern treatments prevent irreversible joint damage in up to 90% of people with RA.

An Aggressive Approach

In the past, a significant percentage of people with RA became disabled, so doctors wanted to find ways to improve the prognosis and keep people more functional.

Now, research and clinical evidence have shown that early diagnosis and treatment with disease-modifying anti-rheumatic drugs (DMARDs) and/or biologics offers the best chance of preventing permanent joint damage later on. These medications also lower your risk of disability and mortality associated with the disease.

According to research published in 2018, each person with RA has a 15% increased chance of dying early due to the disease, its complications, or complications from treatment. That number dropped significantly after 2006, likely due to improved treatment options.

A Window of Opportunity

Multiple studies show that RA treatment has the greatest impact on disease progression when it's started within a specific time frame that's often referred to as "The Window of Opportunity." Starting treatment then can give you your best shot at rheumatoid arthritis remission or at least slower disease progression and better long-term joint function. The more researchers have studied this phenomenon, the more they've narrowed the window on the optimal time frame.

The difference in outcomes is considered large enough that doctors will now often take an aggressive approach to undifferentiated arthritis, which is a diagnosis that often precedes an RA diagnosis, with the hope of preventing its progression to full-blown RA.

Prescription Drug Options

Typically, if you're at low risk for joint damage from RA, you'll be treated with older DMARD medications that are thought to have a low potential for side effects, including:

Medications used for moderate-to-severe rheumatoid arthritis come from several drug classes, and new drugs are always in the pipeline.

DMARDs

DMARDs are most often the first drug doctors prescribe. If you don't tolerate them or they're not improving your condition enough, they may switch you to a biologic or JAK inhibitor, or they may keep you on the DMARD and add other medications.

Common DMARDs include:

Methotrexate has been around for a long time and is relatively inexpensive, so it's often the drug doctors will start with.

Biologics

Biologic drugs are derived from living cells. Several biologics on the market are:

JAK Inhibitors

JAK inhibitors block the action of Janus kinase enzymes, which are involved in the autoimmune response and inflammation. This is a new and growing class that includes drugs such as:

The corticosteroid prednisone, in low doses, may also have some disease-modifying benefit.

Signs and Symptoms of Joint Damage

When rheumatoid arthritis isn't properly treated, it can lead to permanent joint damage and disability. You and your doctor should keep an eye out for signs and symptoms of joint damage. These include:

It's not always possible to predict who will develop joint damage. As a result, if you have symptoms of rheumatoid arthritis, make sure you talk to a doctor, get a proper diagnosis, and, if necessary, start exploring treatment options.

A Word From Verywell

If your RA took a long time to diagnose or you weren't able to start aggressive treatment promptly for any reason, don't despair. With proper medical guidance and an ever-increasing number of drug options, you may still be able to reduce your symptoms, improve your quality of life, and possibly even halt disease progression or go into remission.

On the other hand, if you got a quick diagnosis and are able to start aggressive treatment soon, the prognosis has never been better.

Either way, working with your doctor to find the right treatment regimen and lifestyle changes for you can help put you on the road to feeling and functioning better.

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  1. Aletaha D, Smolen JS. Diagnosis and management of rheumatoid arthritis: A reviewJAMA. 2018;320(13):1360-1372. doi:10.1001/jama.2018.13103

  2. Kyburz D, Finckh A. The importance of early treatment for the prognosis of rheumatoid arthritisSwiss Med Wkly. 2013;143:w13865. Published 2013 Sep 19. doi:10.4414/smw.2013.13865

  3. Listing J, Kekow J, Manger B, et al. Mortality in rheumatoid arthritis: the impact of disease activity, treatment with glucocorticoids, TNFα inhibitors and rituximabAnn Rheum Dis. 2015;74(2):415-421. doi:10.1136/annrheumdis-2013-204021

  4. Abhishek A, Nakafero G, Kuo CF, et al. Rheumatoid arthritis and excess mortality: down but not out. A primary care cohort study using data from Clinical Practice Research DatalinkRheumatology (Oxford). 2018;57(6):977-981. doi:10.1093/rheumatology/key013

  5. van Nies JA, Tsonaka R, Gaujoux-Viala C, Fautrel B, van der Helm-van Mil AH. Evaluating relationships between symptom duration and persistence of rheumatoid arthritis: does a window of opportunity exist? Results on the Leiden early arthritis clinic and ESPOIR cohortsAnn Rheum Dis. 2015;74(5):806-812. doi:10.1136/annrheumdis-2014-206047

  6. Lopez-Olivo MA, Kakpovbia-Eshareturi V, des Bordes JK, Barbo A, Christensen R, Suarez-Almazor ME. Treating early undifferentiated arthritis: A systematic review and meta-analysis of direct and indirect trial evidenceArthritis Care Res (Hoboken). 2018;70(9):1355-1365. doi:10.1002/acr.23474

  7. Johns Hopkins Arthritis Center. Rheumatoid arthritis signs and symptoms.

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