Disease-modifying agents are not necessarily disease modifying. People are still progressing. We either are not hitting them early enough or these medications still aren t doing the job to control the disease. We are still seeing significant radiographic disease as early as a couple of years. We are still seeing that methotrexate is being used earlier and earlier and earlier, and more widespread.
Most rheumatologists now use methotrexate first and ask questions later.
But it s getting more and more that way. There are certain other institutions where they are trying very aggressive treatment. If you are not completely better in three months we are putting you on azathioprine. We don t know yet. We don t have enough history here.