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Treat Rheumatoid Arthritis Early

Studies Show Early, Aggressive Treatment May Lead to Remission
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Role of 'Personalized' Medicine

These findings point to a role for personalized medicine, says researcher Tom W.J. Huizinga, MD, chairman of rheumatology at Leiden University Medical Center in the Netherlands. "If you have autoantibodies to anti-CCP and are treated with methotrexate, you don't develop RA," he says.

"The bottom line is that patients should be referred to a rheumatologist early and if they are CCP positive, they should be treated," he says.

Steven B. Abramson, MD, the director of rheumatology at New York University and the Hospital for Joint Diseases in New York City, agrees. "This is a very exciting article [and] it clearly needs to be validated," he says. "This is the beginning of personalized medicine.

"Patients today should want to know if they are CCP positive and if they are, they should make sure their doctors treat them if they have any symptoms," he says.

Early Treatment

The second study, dubbed the BeSt study, involved a three-year follow-up that compared four of the most widely used treatments for early rheumatoid arthritis.

After two years, 55% of people treated with methotrexate plus Remicade were able to stop Remicade without relapsing and then taper off of methotrexate. By the third year, a substantial number of patients who had stopped taking Remicade were able to stop taking methotrexate and remained disease-free.

"We are very excited because this very new approach to disease hit them very early and hit them very hard with a combination of drugs," leading to remission and discontinuation of the drugs, says researcher Cornelia F. Allaart, MD, a rheumatologist at Leiden University Medical Center in Leiden, Netherlands.

Caution Urged

"These were highly selected study populations from small, highly selected study centers," cautions Iain B. McInnes, FRCP, PhD, professor of experimental medicine and rheumatology at the University of Glasgow in Scotland. "We need a whole lot more data before we can apply this to our practice," he tells WebMD. "It looks like there is a window of opportunity early in disease, but how we best target it, when we should start treatment, what drugs we should use -- and on who -- is not yet known."

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