Early treatment significantly reduces joint damage in rheumatoid arthritis

Early and consistently managed treatment can have a decisive impact on the course of rheumatoid arthritis and prevent permanent joint damage. An international review led by Josef S. Smolen of the Medical University of Vienna highlights which diagnostic and therapeutic measures are crucial a good outcome in patients with this disease, based on the current state of research. The analysis, published in the leading journal JAMA, summarises the evidence on the aetiology, diagnosis, treatment and prognosis of the disease.

For the review, the research team from the Medical University of Vienna and Stanford University (USA) screened 15,886 scientific publications. Following a detailed assessment of 620 papers, 120 studies were included in the analysis, comprising 43 randomised clinical trials, 28 cohort studies, eleven systematic reviews and meta-analyses, as well as 15 international guidelines and recommendations for clinical practice. The results show that the timing of diagnosis is crucial for the course of the disease. If the condition is detected, ideally within six weeks from onset of the first symptoms, treatment with disease-modifying antirheumatic drugs (DMARDs) can be started at an early stage and be particularly successful. These DMARDs suppress inflammation and can prevent joint damage and further progression of the disease.

Clear treatment target, consistent adjustment of treatment

The aim of treatment is to achieve at least a 50 per cent reduction in disease activity within three months, as well as remission – that is, being symptom-free – or at least low disease activity after six months.” 

Josef S. Smolen, study lead, Division of Rheumatology, Department of Medicine III, MedUni Vienna

As first-line therapy, current European recommendations propose the drug methotrexate, supplemented ideally by a temporary course of glucocorticoids. Around 40 per cent of patients achieve the primary treatment goal of remission within six months with this therapeutic approach. If this target is not achieved, the addition of biological agents or Janus kinase inhibitors (JAK inhibitors) – drugs that interfere with specific cells, molecules or signalling pathways of the immune system – increases the proportion of patients in remission or with low disease activity to around 80 per cent over the course of the disease.

The study authors also emphasise the importance of the so-called “treat-to-target” approach. This involves monitoring disease activity regularly by using standardised measurement tools and adjusting treatment at an early stage if necessary. This structured approach has been shown to improve treatment outcomes compared with routine care without defined treatment targets.

Rheumatoid arthritis is a chronic autoimmune disease in which the immune system attacks the synovial membrane. The resulting inflammation can cause permanent damage to cartilage and bone and lead to lasting functional limitations. “The scientific evidence now clearly shows that an early diagnosis, a clearly defined treatment target and consistent adjustment of treatment create the best conditions for preventing joint damage and maintaining patients’ quality of life in the long term,” says co-author Daniel Aletaha, Head of the Division of Rheumatology at MedUni Vienna.