title: Established rheumatoid arthritis: rationale for best practice: physicians' perspective of how to realise tight control in clinical practice.
abstract: Developments in the understanding of the pathogenesis of rheumatoid arthritis (RA) and the introduction of targeted biologic therapies have greatly advanced the management of RA in clinical practice. The management of RA is now aimed at achieving remission, to prevent joint damage and disability. In particular, a critical period early in disease is recognised, in which early aggressive treatment with disease-modifying therapy is advocated. Although a state of remission is the ideal, this chapter discusses the difficulties which may arise in achieving this goal in patients with established disease. The evidence for best management, aimed at achieving clinical remission in established disease, is reviewed. The consequences of incomplete control of chronic inflammation in established disease, including pain, disability and co-morbidities (such as cardiovascular disease and osteoporosis), also pose a significant clinical challenge. The rationale for a multidisciplinary team approach in reducing the associated morbidity and mortality of the disease are examined.
authors.affiliation: Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, UK.
authors.forename: S C
authors.initials: SC
authors.lastname: Horton
authors.forename: C A E
authors.initials: CA
authors.lastname: Walsh
authors.forename: P
authors.initials: P
authors.lastname: Emery
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007596:Joints / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D010024:Osteoporosis / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D059408:Pain Management; D010348:Patient Care Team; D026741:Physical Therapy Modalities; D010818:Practice Patterns, Physicians'; D011364:Professional Practice; D012074:Remission Induction; D013997:Time Factors
chemical_list: D018501:Antirheumatic Agents