To achieve better functioning, quality of life, reduction of comorbidities and enhanced survival for their patients with rheumatoid arthritis, Mayo Clinic rheumatologists have used more aggressive treatments shortly after diagnoses and throughout disease duration.
Physicians in the clinic’s rheumatology division in Rochester, Minn., use a management approach that assimilates current experience, expert opinion and clinical experience, according to practices from a recent report.
“Timely intervention and accurate diagnosis reduce the progression of rheumatoid arthritis, with the result that outcomes have globally improved with more patients able to work and less need for joint reconstructive surgery than in past decades,” the researchers said. “Application of the 2010 [American College of Rheumatology/European League Against Rheumatism] classification criteria for rheumatoid arthritis facilitates early diagnosis, which is critical to the highest probability of clinical remission with disease-modifying therapy.”
John M. Davis III, MD
Mayo Clinic rheumatologists favor methotrexate, along with prednisone, as treatment for most newly diagnosed patients with RA. And other clinicians might be surprised by the emphasis on oral corticosteroid therapy as part of the initial management approach, John M. Davis III, MD, told Healio.com.
“This is based on evidence that prednisone therapy, by helping to induce rapid control of inflammation, has a long-lasting disease-modifying effect in early disease,” said Davis, co-author of the report with Eric L. Matteson, MD, MPH. “The known risks for therapy are balanced by relatively rapid tapering to low doses and guidelines for limiting long-term use. In the long term, our approach emphasizes use of combinations of disease-modifying medications and biologics to achieve disease activity targets.”
A “treat-to-target” principal is recommended in RA treatment, Davis said. The European League Against Rheumatism indicated in a recent consensus statement that the primary objective is remission, defined as an absence of signs or symptoms of inflammatory disease activity.
Three months after therapy initiation is the most opportune time to assess the probability of attaining clinical remission at 1 year, according to the report.
“The current approach to the management of rheumatoid arthritis should be based on a standardized, goal-directed approach, yet ultimately individualized based on individual factors, patient preferences, and comorbidities, in order to achieve optimal, patient-centered outcomes,” Davis said.
Disclosure: See the study for a full list of relevant disclosures.