Rheumatoid arthritis: should we shift the focus from 'Treat to Target' to 'Treat to Work?'.

摘要

Rheumatoid arthritis (RA) is a chronic inflammatory disorder characterized by progressive inflammatory synovitis and destruction of articular cartilage and marginal bone. Joint erosion can be seen within 6 months of disease onset in the majority of patients and occurs more rapidly in the first year than in late-stage disease [1]. Historical studies have demonstrated that moderate disability within 2 years of diagnosis is not uncommon, and up to 30 % of patients may be unable to work after 10 years [2], Improvement in disability, as measured by Health Assessment Questionnaire (HAQ) disability index scores, can be demonstrated in the short term with DMARD therapy, but the magnitude of this improvement is substantially greater among patients with early disease than among those with more advanced disease [3]. Longitudinal studies of RA patients show that there is a progressive decline in HAQ scores with time [3, 4], Early interventions that prevent irreversible damage would appear to offer the best opportunities for achievement of favorable outcomes in patients with early, aggressive RA. In early intervention studies that measured radiographic progression, this therapeutic window can be as small as a few months [5, 6]. In addition to early therapy, combination treatment has been shown to result in more favorable short-term and long-term outcomes than monotherapy [5, 7].