Rheumatoid Arthritis: Treat Now, Not Later!
Authors: Michael E. Weinblatt
Journal: Annals of Internal Medicine (1996)

Editorials15 April 1996Rheumatoid Arthritis: Treat Now, Not Later!Michael E. Weinblatt, MDMichael E. Weinblatt, MDBrigham and Women's Hospital, Harvard Medical School, Boston, MA 02115Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-124-8-199604150-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Over the past several years, a new approach to the treatment of rheumatoid arthritis has evolved. Rheumatologists now advocate earlier initiation of therapy with a group of heterogeneous drugs termed either "DMARDs" (disease-modifying antirheumatic drugs), "SAARDs" (slow-acting antirheumatic drugs), or "second-line therapies." These drugs include hydroxychloroquine, sulfasalazine, methotrexate, gold salts, D-penicillamine, azathioprine, and cyclosporine.The old paradigm of therapy was called the "pyramid approach." The bottom of the pyramid included anti-inflammatory drugs, such as aspirin and nonsteroidal anti-inflammatory drugs, that were prescribed along with a basic program of exercise, rest, and education. Second-line therapy was initiated only after several years ...References1. Wilske KR, Healey LA. Remodeling the pyramid—a concept whose time has come. J Rheumatol. 1989; 16:565-7. Google Scholar2. Kushner I, Dawson NV. Changing perspectives in the treatment of rheumatoid arthritis [Editorial]. J Rheumatol. 1992; 19:1831-4. Google Scholar3. Pincus T, Callahan LF. Remodeling the pyramid or remodeling the paradigms concerning rheumatoid arthritis—lessons from Hodgkin's disease and coronary artery disease [Editorial]. J Rheumatol. 1990; 17:1582-5. Google Scholar4. McCarty DJ. Suppress rheumatoid inflammation and leave the pyramid to the Egyptians [Editorial]. J Rheumatol. 1990; 17:1115-8. Google Scholar5. Pincus T, Callahan LF. Taking mortality in rheumatoid arthritis seriously—predictive markers, socioeconomic status and comorbidity. J Rheumatol. 1986; 13:841-5. Google Scholar6. Wolfe F, Hawley DJ, Cathey MA. Clinical and health status measures over time: prognosis and outcome assessment in rheumatoid arthritis. J Rheumatol. 1991; 18:1290-7. Google Scholar7. Mitchell JM, Burkhauser RV, Pincus T. The importance of age, education, and comorbidity in the substantial eamings losses of individuals with symmetric polyarthritis. Arthritis Rheum. 1988; 31:348-57. Google Scholar8. Felts W, Yelin E. The economic impact of the rheumatic diseases in the United States. J Rheumatol. 1989; 16:867-84. Google Scholar9. Fuchs HA, Kaye JJ, Callahan LF, Nance EP, Pincus T. Evidence of significant radiographic damage in rheumatoid arthritis within the first 2 years of disease. J Rheumatol. 1989; 16:585-91. Google Scholar10. van der Heijde DM, van Leeuwen MA, van Riel PL, Koster AM, van't Hof MA, van Rijswijk MH, et al. Biannual radiographic assessments of hands and feet in a three-year prospective followup of patients with early rheumatoid arthritis. Arthritis Rheum. 1992; 35:26-34. Google Scholar11. Iannuzzi L, Dawson N, Zein N, Kushner I. Does drug therapy slow radiographic deterioration in rheumatoid arthritis? N Engl J Med. 1983; 309:1023-8. Google Scholar12. van Riel PL, van der Heijde DM, Nuver-Zwart IH, van de Putte LB. Radiographic progression in rheumatoid arthritis: results of 3 comparative trials. J Rheumatol. 1995; 22:1797-9. Google Scholar13. van der Heijde DM, van Riel PL, Nuver-Zwart IH, Gribnau FW, vad de Putte LB. Effects of hydroxychloroquine and sulphasalazine on progression of joint damage in rheumatoid arthritis. Lancet. 1989; 1:1036-8. Google Scholar14. Weinblatt ME, Polisson R, Blotner SD, Sosman JL, Aliabadi P, Baker N, et al. The effects of drug therapy on radiographic progression of rheumatoid arthritis. Results of a 36-week randomized trial comparing methotrexate and auranofin. Arthritis Rheum. 1993; 36:613-9. Google Scholar15. van der Heide A, Jacobs JW, Bijlsma JW, Heurkens AH, van Booma-Frankfort C, et al. The effectiveness of early treatment with "second-line" antirheumatic drugs. A randomized, controlled trial. Ann Intern Med. 1996; 124:699-707. Google Scholar16. Suarez-Almazor ME, Soskolne CL, Saunders LD, Russell AS. Outcome in rheumatoid arthritis. A 1985 inception cohort study. J Rheumatol. 1994; 21:1438-46. Google Scholar17. Egsmose C, Lund B, Borg G, Pettersson H, Berg E, Brodin U, et al. Patients with rheumatoid arthritis benefit from early 2nd line therapy: 5 year followup of a prospective double blind placebo controlled study. J Rheumatol. 1995; 22:2208-13. Google Scholar18. Ward MM, Leigh JP, Fries JF. Progression of functional disability in patients with rheumatoid arthritis. Associations with rheumatology subspecialty care. Arch Intem Med. 1993; 153:2229-37. Google Scholar19. Chan KW, Felson DT, Yood RA, Walker AM. The lag time between onset of symptoms and diagnosis of rheumatoid arthritis. Arthritis Rheum. 1994; 37:814-20. Google Scholar Author, Article, and Disclosure InformationAuthors: Michael E. Weinblatt, MDAffiliations: Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115Corresponding Author: Michael Weinblatt, MD, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Effectiveness of Early Treatment with "Second-Line" Antirheumatic Drugs Agnes van der Heide , Johannes W.G. Jacobs , Johannes W.J. Bijlsma , Anton H.M. Heurkens , Christina van Booma-Frankfort , Maaike J. van der Veen , Huub C.M. Haanen , and Dick M. Hofman Metrics Cited byAlternative tumour necrosis factor inhibitors (TNFi) or abatacept or rituximab following failure of initial TNFi in rheumatoid arthritis: the SWITCH RCTDelays in Initiation of Disease-Modifying Therapy in Rheumatoid Arthritis Patients: Data from a US-Based RegistryTherapeutic effect of dimethyl dimethoxy biphenyl dicarboxylate on collagen-induced arthritis in ratsComparing Five Year Out-Come in Two Cohorts of Patients with Early Rheumatoid Arthritis – A BARFOT StudyRheumaSCORE: A CAD System for Rheumatoid Arthritis Diagnosis and Follow-UpThe 'Switch' study protocol: a randomised-controlled trial of switching to an alternative tumour-necrosis factor (TNF)-inhibitor drug or abatacept or rituximab in patients with rheumatoid arthritis who have failed an initial TNF-inhibitor drugNimesulide Improves the Symptomatic and Disease Modifying Effects of Leflunomide in Collagen Induced ArthritisComputer Aided Diagnosis: State-of-the-Art and Application to Musculoskeletal DiseasesSurgical Treatment of the Cervical Spine in Rheumatoid ArthritisEfficacy and Safety of Rituximab in Biologic-Naive Patients with Rheumatoid Arthritis vs Anti-Tnf Therapy FailureExploiting 3D Part-Based Analysis, Description and Indexing to Support Medical ApplicationsEconomic benefits of optimizing anchor therapy for rheumatoid arthritisEarly ArthriticsRemission: a realistic goal in rheumatoid arthritis?Economic consequences and potential benefitsNimesulide improves the disease modifying anti-rheumatic profile of methotrexate in mice with collagen-induced arthritisGender Issues in the Diagnosis and Treatment of Chronic IllnessThe Rheumatoid Cervical SpineJoint Counts to Assess Rheumatoid Arthritis for Clinical Research and Usual Clinical Care: Advantages and LimitationsThe Gap Between Practice and Guidelines in the Choice of First-line Disease Modifying Antirheumatic Drug in Early Rheumatoid Arthritis: Results from the ESPOIR CohortRHEUMATOID ARTHRITISAscendancy of weekly low-dose methotrexate in usual care of rheumatoid arthritis from 1980 to 2004 at two sites in Finland and the United StatesQuantitative assessment of rheumatoid arthritis in standard clinical care: turning clinical care into clinical scienceQuantitative measures of rheumatic diseases for clinical research versus standard clinical care: differences, advantages and limitationsOutcomes in rheumatoid arthritis: incorporating the patient perspectivePrevalence and impact of arthritis: Opportunities for preventionQuantitative Measures to Assess Patients with Rheumatic Diseases: 2006 UpdateAcute polyarthritisShould aggressive therapy for rheumatoid arthritis require early use of weekly low-dose methotrexate, as the first disease-modifying anti-rheumatic drug in most patients?Conventional Disease-Modifying Antirheumatic Drugs in Early ArthritisPatients seen for standard rheumatoid arthritis care have significantly better articular, radiographic, laboratory, and functional status in 2000 than in 1985Artemether: A New Therapeutic Strategy in Experimental Rheumatoid ArthritisAnakinra: Review of recombinant human interleukin-I receptor antagonist in the treatment of rheumatoid arthritisQuantitative measures and indices to assess rheumatoid arthritis in clinical trials and clinical careEligibility of patients in routine care for major clinical trials of anti-tumor necrosis factor ? agents in rheumatoid arthritisDose-effect relationships of nonsteroidal anti-inflammatory drugs: a literature reviewNew Developments in Laboratory Tests and Therapy for Rheumatoid ArthritisUrgent care and tight control of rheumatoid arthritis as in diabetes and hypertension: Better treatments but a shortage of rheumatologistsPremature mortality in patients with rheumatoid arthritis: Evolving conceptsHow can the risk of long-term consequences of rheumatoid arthritis be reduced?Combination Therapy with Multiple Disease-Modifying Antirheumatic Drugs in Rheumatoid Arthritis: A Preventive StrategyTheodore Pincus, MD, James R. O'Dell, MD, and Joel M. Kremer, MDACR 20: Clinical or statistical significance?Remodeling the therapeutic pyramid: evolving therapeutic strategies for rheumatoid arthritisRemodeling the therapeutic pyramid: evolving therapeutic strategies for rheumatoid arthritisLong-term outcome of total lymphoid irradiation in rheumatoid arthritis: Comment on the article by Westhovens et al 15 April 1996Volume 124, Issue 8Page: 773-774KeywordsDisabilitiesDisease modifying antirheumatic drugsDrug interactionsDrug therapyDrugsHydroxychloroquineMethotrexateRheumatoid arthritisSaltsToxicity ePublished: 15 August 2000 Issue Published: 15 April 1996 Copyright & PermissionsCopyright © 1996 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...