title: The optimal combination therapy for the treatment of early rheumatoid arthritis.
abstract: BACKGROUND
  Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune condition traditionally viewed as a severe destructive disease affecting physical health and global wellbeing. The treatment strategies for RA have changed in the last decades from mainly symptomatic towards a more vigorous and targeted approach.
  
  
  METHODS
  Reviewing recent literature enhanced by own expertise and research, a case is made for starting early with an intensive combination treatment with glucocorticoids, followed by a treat to target approach in a tight control setting. Implementation issues that need to be addressed to make optimal use of the 'window of opportunity' are highlighted.
  
  
  CONCLUSIONS
  There is strong evidence in favor of traditional synthetic disease-modifying anti-rheumatic drugs (DMARDs) combined with a remission induction scheme of glucocorticoids to achieve adequate efficacy in controlling early rheumatoid arthritis with good safety and feasibility in daily clinical practice. Furthermore, the most optimal RA treatment should address not only the physician-oriented clinical disease outcomes but also the patient perspective. There is still a need for working on improving implementation of this approach in daily practice in order to provide optimal treatment benefit to more patients.
authors.affiliation: Skeletal Biology and Engineering Research Center, KU Leuven Department of Development and Regeneration , Leuven , Belgium +016 346 350 ; +016 342 543 ; diederik.decock@med.kuleuven.be.
authors.forename: Diederik
authors.initials: D
authors.lastname: De Cock
authors.forename: Kristien
authors.initials: K
authors.lastname: Van der Elst
authors.forename: Sabrina
authors.initials: S
authors.lastname: Meyfroidt
authors.forename: Patrick
authors.initials: P
authors.lastname: Verschueren
authors.forename: René
authors.initials: R
authors.lastname: Westhovens
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids
keywords: biological; combination treatment; glucocorticoids; methotrexate; patient perspective; rheumatoid arthritis; treat to target; window of opportunity