With the implementation of new treatment options, including biologicals and the early, agressive start of target-steered treatment the outlook for rheumatoid arthritis patients improved... Show moreWith the implementation of new treatment options, including biologicals and the early, agressive start of target-steered treatment the outlook for rheumatoid arthritis patients improved considerably the past decades. This thesis describes several aspects of modern rheumatoid arthritis treatment from the perspective of the BeSt study, a randomised controlled trial comparing four treatment strategies. The main findings from BeSt were that initial combination therapy, including high dose prednisone or the tumour necrosis factor inhibitor infliximab led to an earlier improvement in functional limitations and quality of life, earlier clinical remission and less joint damage after 5 years of follow-up than initial monotherapy. From one year onwards clinical outcomes were comparable across the groups. Drug free remission was possible in up to 20% of patients. Besides the primary outcomes of the BeSt study, this thesis de scribes the association between disease activity and functional capacity, the association between clinical signs of synovitis and joint damage progression at joint level, a comparison between disease activity measures and remission criteria, a comparison between radiological scoring methods, an evaluation of the effect of discontinuation of medication in case of low disease activity and remission and the association between disease activity, treatment and blood pressure. Show less
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... Show morePatients 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. Show less
