Strategies for optimal suppression of rheumatoid arthritis

Abstract

Patients with recent onset RA benefit from dynamic treatment strategies in which treatments are continuously being adjusted on the basis of regular assessments of disease activity, according to a predefined treatment protocol. Remission, with and even without maintenance therapy, is a realistic goal. Pharmacogenetics may provide useful information on initial treatment decisions, but as long as accurate prediction of response to treatment and disease severity is not possible, all patients with RA should be treated with initial combination therapy shortly after symptom onset. Which is the best combination to start with is not crystallized, and depends on the long term outcomes of drug-free remission, safety and cost-utility analyses. By incorporating the newest treatment options into these strategies, hopefully in the future rheumatoid arthritis will no longer be a chronic disease.