Early Therapy Helps Rheumatoid Arthritis Patients
WebMD News Archive
March 9, 2000 (Minneapolis) -- People with rheumatoid arthritis who receive
early and aggressive treatment called "second-line" therapy have less
pain and disability than those for whom the treatment is delayed, Canadian
researchers report in the Journal of Rheumatology.
The initial treatment of rheumatoid arthritis has traditionally been
anti-inflammatory agents, such as aspirin or ibuprofen. In the last few years,
studies have supported the use of second-line therapy with drugs such as
methotrexate, gold salts, or hydroxychloroquine to decrease the pain and
disability associated with the disease. But doctors have not known whether
early treatment with these drugs, as opposed to the "watchful waiting"
approach, would offer more relief.
"Rheumatologists believe in early use of second-line treatments for
rheumatoid arthritis, but we haven't had evidence to support it before this
study," study co-author John M. Esdaile, MD, tells WebMD. He says this
approach "reflects a radical shift in philosophy that may not have reached
primary care providers yet."
Rheumatoid arthritis affects multiple joints, causing them to swell, says
Esdaile, a professor and head of rheumatology at the University of British
Columbia in Vancouver. He is also the associate director of research of the
Canadian Arthritis Network.
People with this condition, which commonly affects the hands and wrists as
well as the neck and knees, are typically stiff for more than an hour when they
arise in the morning. They also suffer from fatigue. "Not everyone with
joint pain has rheumatoid arthritis, but anyone with these symptoms should be
assessed by their physician," Esdaile tells WebMD.
He says that 20 years ago, doctors had only one second-line agent, gold
salt, to use in these patients. "Now we have an increasing number of
second-line treatments, and our philosophy has changed toward aggressive
treatment: treat more, treat earlier," he says. "People need to know
that rheumatoid arthritis is a serious disease, and early treatment is required
to prevent subsequent joint damage."
The second-line treatment used in this study was hydroxychloroquine, which
is commonly used to treat rheumatoid arthritis. Researchers gave either
hydroxychloroquine or a placebo to 119 rheumatoid arthritis patients for nine
months, then followed them for three years.