Early Drug Treatment Is Crucial for Rheumatoid Arthritis


Early treatment for rheumatoid arthritis is critical—but patients don't always get it, new studies show.

Rheumatoid arthritis is an autoimmune disease that results in inflammation of the joints and possibly other organs and tissues. Its cause is unknown, but it occurs most commonly in middle age. Symptoms can include morning stiffness, joint pain, dry mouth and eyes, chest pain when breathing, nodules under the skin and numbness, burning or tingling in the extremities. According to the Arthritis Foundation, the disease affects 2.1 million Americans; about 1.5 million are women

A growing body of evidence points to the importance of beginning treatment early. In one of the latest studies, published in Arthritis & Rheumatism in July, researchers at Lapeyronie Hospital looked at x-rays showing structural damage to joints of French patients with the disease. The patients had an average age of 49, and three-quarters were women.

Within one year of diagnosis, 437 patients began treatment with a disease-modifying drug. Most used methotrexate, though some used other medications such as hydroxychloroquine, sulfasalazine, or tumor necrosis factor blockers. For those with the most severe form of the disease, early treatment made a significant difference in the amount of damage to the joints, the study showed.

However, because there's often a delay between when patients see their general practitioners and when they finally see a rheumatologist and begin treatment, they sometimes miss the effective window of treatment. A University of Birmingham study published in the Aug. 7 issue of the Annals of the Rheumatic Diseases followed 482 patients in eight European countries. It showed an average delay of 24 weeks from the onset of symptoms to when they were first seen by a rheumatologist. A 2007 study in the United States showed an average delay of about 20 weeks between the onset of symptoms and treatment.

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