Early Therapy Helps Rheumatoid Arthritis Patients
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.
They found that the patients who received treatment with hydroxychloroquine
soon after being diagnosed had much less pain during the three years and
experienced significantly less disability. Those who did not have early
treatment never caught up with the other group, according to the
"This is a fascinating study because it validates early treatment of
rheumatoid arthritis. It's very important for patients to get help early when
they have joint pain," says Carolyn Bell, MD, who reviewed the study for
WebMD. Bell, a professor of medicine in rheumatology at the University of
Wisconsin-Madison participated in early studies of hydroxychloroquine.
"Rheumatologists now believe that there is a window of time that
provides the best opportunity to treat rheumatoid arthritis," she says.
"We want to catch it before it spreads in order to have better control of
- Rheumatoid arthritis is a disease that affects multiple joints, causing
stiffness and fatigue.
- New research supports the idea that patients with rheumatoid arthritis
should be treated early and aggressively.
- Patients who were taking so-called second-line medications fared better
with respect to pain and physical functioning.