The value of early intervention in RA—a window of opportunity
- 25 February 2011
- journal article
- review article
- Published by Springer Science and Business Media LLC in Clinical Rheumatology
- Vol. 30 (1), 33-39
- https://doi.org/10.1007/s10067-010-1638-5
Abstract
Rheumatoid arthritis (RA) is associated with progressive joint destruction, with functional status influenced by both disease activity and radiographic progression. The case for early aggressive treatment of RA is based on large amounts of good data in many countries. Studies with conventional disease-modifying anti-rheumatic drugs in early RA have shown improved outcomes compared with later treatment, especially if an aggressive approach with combinations of drugs is used. Early intervention with tumour necrosis factor (TNF) inhibitors has been shown to improve clinical outcomes, induce remission and prevent radiographic progression. It also improves patients’ functional status, health-related quality of life, and reduces fatigue. Patients with RA have reduced productivity, an increased number of lost work days and retire early; enabling patients to work should be at the core of a therapy’s cost-effectiveness. Introduction of anti-TNF therapy early in RA has been shown to decrease job loss and reduce the amount of working time missed. Although the drug costs of initial treatment with combination therapy including a TNF inhibitor are high, these may be compensated by the reduction in lost productivity, making such a strategy cost-effective overall. In addition, some patients who respond well to combination therapy may be able to stop the TNF inhibitor. It is important to assess the benefits of any intervention not just to healthcare costs but to society as a whole, and physicians should be advocates for optimal access to effective therapies for their patients.This publication has 34 references indexed in Scilit:
- Discontinuation of infliximab after attaining low disease activity in patients with rheumatoid arthritis: RRR (remission induction by Remicade in RA) studyAnnals Of The Rheumatic Diseases, 2010
- Patients with rheumatoid arthritis treated with tumour necrosis factor antagonists increase their participation in the workforce: potential for significant long-term indirect cost gains (data from a population-based registry)Annals Of The Rheumatic Diseases, 2009
- Less Radiographic Progression with Adalimumab Plus Methotrexate Versus Methotrexate Monotherapy Across the Spectrum of Clinical Response in Early Rheumatoid ArthritisThe Journal of Rheumatology, 2009
- Patient-reported outcomes improve with etanercept plus methotrexate in active early rheumatoid arthritis and the improvement is strongly associated with remission: the COMET trialAnnals Of The Rheumatic Diseases, 2009
- The Gap Between Practice and Guidelines in the Choice of First-line Disease Modifying Antirheumatic Drug in Early Rheumatoid Arthritis: Results from the ESPOIR CohortThe Journal of Rheumatology, 2009
- Cost‐utility analysis of treatment strategies in patients with recent‐onset rheumatoid arthritisArthritis Care & Research, 2009
- Long‐term impact of early treatment on radiographic progression in rheumatoid arthritis: A meta‐analysisArthritis Care & Research, 2006
- Measuring function in rheumatoid arthritis: Identifying reversible and irreversible componentsArthritis & Rheumatism, 2006
- Etanercept versus methotrexate in patients with early rheumatoid arthritis: Two‐year radiographic and clinical outcomesArthritis & Rheumatism, 2002
- Factors predicting response to treatment in rheumatoid arthritis: The importance of disease durationArthritis & Rheumatism, 2000