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Fast Diagnosis and Treatment Key to Managing Rheumatoid Arthritis


WebMD Health News

Jan. 13, 2000 (Los Angeles) -- Early diagnosis and prompt, appropriate treatment of rheumatoid arthritis (RA) are the keys to minimizing joint and tissue damage and enhancing quality of life, according to rheumatologist Eric L. Matteson, MD. Matteson reviewed the latest RA treatment strategies in the journal Mayo Clinic Proceedings.

RA is one of the most common causes of disability, writes Matteson, an associate professor of rheumatology and internal medicine at the Mayo Clinic. "After 12 years of disease, more than 80% of patients with RA are partially disabled, and 16% are completely disabled. Life expectancy is shortened by an average of 7 years in men and 3 years in women." Matteson tells WebMD that the most common causes of decreased life expectancy associated with RA are vasculitis, or inflammation of the blood vessels; side effects of drugs, such as bleeding from a stomach ulcer; and an increased risk of infection, which may be due to the drugs suppressing the immune system. On a more optimistic note, he says that doctors now have in their armamentarium new drugs tailored to inhibit specific aspects of RA and these drugs will have a profound effect on the management of this disease.

The goals of therapy are to relieve pain, control inflammation, prevent joint destruction, and maintain normal function as long as possible, he writes. The mainstay of RA therapy should be compounds known as disease-modifying antirheumatic drugs (DMARDs), such as gold, methotrexate, or tumor necrosis factor (TNF) antagonists. Enbrel (etanercept), a TNF antagonist, is genetically engineered to decrease inflammation, which is a vital part of what causes the pain and destruction associated with RA. These drugs can reduce disability and death associated with RA and should be introduced as soon as RA has been diagnosed.

"Use of DMARDs has substantially improved disease control and the long-term outlook for patients with RA," Matteson writes. Many rheumatologists have come to view methotrexate as the "anchor therapy" for RA, thanks to its good efficacy and relatively mild side effects. In an interview seeking objective comment, John Klippel, MD, medical director of the Arthritis Foundation, tells WebMD that the use of methotrexate and TNF antagonists are the two most significant advances in RA therapy in the past decade.

Steroids are potent suppressors of inflammation and can be used to control severe or widespread disease until the DMARDs take effect, which may take several weeks to months. However, steroids cause serious side effects, such as infection and increased blood sugar. Matteson recommends that they not be used alone in RA therapy and should be tapered and ultimately discontinued as soon as other agents start to work. DMARDs also can be tapered in a patient who has no active signs of disease for at least a year.

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