title: Advances in the management of rheumatoid arthritis.
abstract: Modern early rheumatoid arthritis strategies are usually based upon a number of important overarching principles: 1. early diagnosis facilitates early commencement of disease modifying anti-rheumatic therapy; 2. early commencement of treatment reduces the long-term risk of erosive damage and functional decline; 3. composite disease activity measures should be used to quantify global rheumatoid arthritis disease activity; and 4. therapy should be intensified until a predefined disease activity target has been achieved. A substantial minority of rheumatoid arthritis patients (approximately 40%) will experience an adequate response to methotrexate monotherapy; however, the remainder may require disease modifying anti-rheumatic combination therapy, and/or biologic therapy, to achieve disease activity targets. Importantly, short term trials of methotrexate monotherapy do not appear to disadvantage outcomes provided treatment continues to be intensified if disease activity targets are not achieved.
authors.affiliation: Honorary Consultant Rheumatologist, NHS Greater Glasgow and Clyde, UK Clinical Lecturer, University of Glasgow, UK Jamesdale1@nhs.net.
authors.forename: James
authors.initials: J
authors.lastname: Dale
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy*; D018450:Disease Progression; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D042241:Early Diagnosis; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use*; D011859:Radiography; D012074:Remission Induction; D012720:Severity of Illness Index
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids; D008727:Methotrexate
keywords: Biologic therapy; disease activity score; disease-modifying anti-rheumatic drugs; rheumatoid arthritis; treat-to-target