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 researchers.
"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 the disease."
- 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.