Treat Rheumatoid Arthritis Early

Studies Show Early, Aggressive Treatment May Lead to Remission

Medically Reviewed by Brunilda Nazario, MD on November 13, 2006

Nov. 13, 2006 (Washington) -- Two studies suggest that treating rheumatoid arthritis (RA) early and aggressively may change its course.

The findings were presented at the 2006 annual meeting of the American College of Rheumatology.

Rheumatoid arthritisis an autoimmune disease caused by the immune system attacking the lining of the joints. It can lead to long-term joint and bone damage and affects 2.1 million Americans, mainly women.

The disease can result in chronic pain, loss of function, and disability, according to the Arthritis Foundation.

There is no cure for the disease. Treatments are aimed at reducing joint inflammation and restoring joint function to near-normal levels.

Early Evidence of Rheumatoid Arthritis

In one study, Dutch researchers studied people with early evidence of rheumatoid arthritis. The researchers show that treating these individuals with the drug methotrexate can possibly prevent the disease from progressing to rheumatoid arthritis.

And in a second study, investigators report that early treatment with methotrexate plus Remicade may result in a drug-free remission in people with rheumatoid arthritis. Remicade is one of a newer category of medications that target specific chemicals that lead to inflammation.

The first study -- called PROMPT -- comprised 110 people with arthritis from an early arthritis clinic in the Netherlands. They received methotrexate or a placebo for one year. Researchers measured joint damage every six months by taking X-rays of the hands and feet -- the joints most commonly affected by rheumatoid arthritis.

People who received methotrexate showed less X-ray damage to the joints after 30 months compared with their counterparts who received a placebo. They were also less likely to develop rheumatoid arthritis, but only if they tested positive for an antibody known as anti-CCP. Anti-CCP antibodies are blood markers that may predict the development of rheumatoid arthritis.

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."

Show Sources

SOURCES: 70th annual meeting of the American College of Rheumatology, Washington, D.C., Nov. 10-15, 2006. Tom W.J. Huizinga, MD, chairman of rheumatology, Leiden University Medical Center, Leiden, Netherlands. Steven B. Abramson, MD, director of rheumatology, New York University and the Hospital for Joint Diseases, New York City. Iain B. McInnes, FRCP, PhD, professor of experimental medicine and rheumatology, University of Glasgow, Scotland. Cornelia F. Allaart, MD, rheumatologist, Leiden University Medical Center, Netherlands.

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