RA Patients Did Well with Specialty Help

Rheumatoid arthritis patients who saw rheumatologist early had good outcomes

(RxWiki News) Controlling the pain and swelling of rheumatoid arthritis is no easy task. As such, treating the disease requires a specialist. A recent study suggests that patients should see a specialist as soon as possible.

These findings suggest that patients who are at risk of developing severe arthritis and who get tested and treated early by a rheumatologist may have a better chance of having mild disease.

In other words, those patients who got early treatment had better odds of keeping the disease from getting worse.

"Seek treatment early for rheumatoid arthritis."

The first several months after patients start experiencing symptoms of rheumatoid arthritis are sometimes called the "window of opportunity." During this time, it is very important for patients to get the right treatment to prevent complications down the road.

For their study, Bernard G. Combe, MD, PhD, of Hopital Lapeyronie in Montpellier, France, and colleagues looked at patients with early rheumatoid arthritis, or patients who had arthritis for less than 6 months who were at risk of developing severe disease.

At the beginning of the study, none of the patients were being treated with disease-modifying anti-rheumatic drugs (DMARDs), which are often the first drugs used to treat rheumatoid arthritis.

On average, patients had a disease activity score (DAS-28) of 5.1, which means they had moderate to severe disease activity.

DAS-28 is a test to measure joints affected by arthritis out of a total of 28 joints. The score ranges from 0 to 10, where 0 means no disease activity and 10 means the most severe disease activity.

The researchers wanted to see if spotting and treating rheumatoid arthritis early would keep the disease from progressing.

Past studies have found that arthritis patients who get specialty care from a rheumatologist can prevent permanent joint damage and organ damage, boost long-term function and increase the chances of putting the disease into remission (lessening or disappearance of symptoms).

Dr. Combe and colleagues followed up with their patients five years after the study began. They found that patients who were spotted with early rheumatoid arthritis five years previously had mild disease activity.

After five years, about 83 percent of patients had received at least one DMARD - mainly methotrexate, the most commonly used DMARD. A total of 18.3 percent of patients received newer treatments called biologics, which include Humira (adalimumab), Enbrel (etanercept) or Remicade (infliximab). Nearly 60 percent of patients received a steroid called prednisone on top of their other medications.

Receiving these medications requires seeing a rheumatologist early in the disease process.

By the end of the study, DAS-28 scores dropped to about 2.5, which is a sign that rheumatoid arthritis may be in remission.

In addition, patients had low scores on the Health Assessment Question Disability Index (HAQ DI). The HAQ DI is a scoring system in which 0 means no disability and 3 means high disability. At the 5-year follow-up, patients had an HAQ DI score of 0.3.

"Early referral to a rheumatologist, early effective treatment and close monitoring are key points in managing rheumatoid arthritis in daily practice," said Dr. Combe.

The study included 813 patients with early rheumatoid arthritis. A total of 573 patients were involved in the 5-year follow-up.

The research was supported by the French Society of Rheumatology, Institut National de la Santé et de la Recherche Medicale and grants from the pharmaceutical companies Merck, Pfizer, Abbott and Roche.

The authors disclosed no conflicts of interest.

The study was presented at the American College of Rheumatology's annual meeting. As such, it has yet to be published in a peer-reviewed journal.

Review Date: 
November 12, 2012