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Treatment strategies in recent onset rheumatoid arthritis

Allaart, Cornelia F; Huizinga, Tom WJ

Current Opinion in Rheumatology: May 2011 - Volume 23 - Issue 3 - p 241–244
doi: 10.1097/BOR.0b013e3283454111
Rheumatoid arthritis: Edited by Ferdinand Breedveld

Purpose of review Treatment of rheumatoid arthritis (RA) requires strategies for treatment timing and treatment choices. To help rheumatologists choose the right treatment at the right time, this review describes recent trial outcomes, and studies into possible predictors for treatment strategy outcomes.

Recent findings Very early treatment with abatacept was clinically effective, but prevention of RA or remission induction has not been achieved. In general, patients with recent onset RA have earlier clinical improvement when treated with initial combination therapy with prednisone or a tumor necrosis factor inhibitor than when treated with initial monotherapy. Recent studies present data on patient-reported outcomes and show that the benefit of suppression of joint damage progression is maintained over time. For individual patients initial monotherapy may be sufficient. Biomarkers for response to treatment are promising, but are not ready for use in daily practice. A recently developed prediction model based on simple clinical predictors may be more useful to avoid overtreatment and undertreatment.

Summary Risk estimation, for instance using a prediction model, may help to decide whether patients with recent onset RA should start with monotherapy or combination therapy. Early treatment is important, but permanent remission induction is still a future target.

Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands

Correspondence to Cornelia F. Allaart, MD, PhD, Department of Rheumatology, C1-41, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands Tel: +31 71 526 3598; fax: +31 71 526 6752; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.