Recent advances in the management of rheumatoid arthritis.

  • Klarenbeek N
  • Kerstens P
  • Huizinga T
 et al. 
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#### Summary points Until the 1990s patients with rheumatoid arthritis were initially treated with aspirin or other non-steroidal anti-inflammatory drugs; disease modifying anti-rheumatic drugs (DMARDs), such as methotrexate, were introduced only as the disease progressed. Combined treatment with more than one DMARD was reserved for patients with the most severe disease. The outcome for most patients was functional deterioration with progressive damage. However, innovations in drugs, better tools for monitoring treatment, and tight control strategies have improved the outlook for patients with rheumatoid arthritis. Remission with limited radiological damage and no functional deterioration is now a realistic treatment goal. Several randomised controlled trials have shown that treatment with DMARDs, corticosteroids, and biological agents early in the course of disease can retard progression of disease, reduce joint destruction, and improve functional ability and health related quality of life. This, along with the introduction of new tools to monitor response to treatment, has led to a new treatment approach and improved outcomes.1 We review evidence from randomised trials, systematic reviews, and recently published guidelines and outline the new approach to treatment, emphasising the importance of early diagnosis, referral, and treatment. #### Sources and selection criteria We used recently published recommendations on the treatment of rheumatoid arthritis. We also searched the Cochrane Database of Systematic Reviews (without time …

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  • Naomi B Klarenbeek

  • Pit J S M Kerstens

  • Tom W J Huizinga

  • Ben A C Dijkmans

  • Cornelia F Allaart

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