Rheumatoid arthritis (RA) is the most common inflammatory form of arthritis, affecting almost two million Americans. It is a chronic, complex, autoimmune, systemic disease for which there is no known cure as of yet. It is characterized by joint inflammation and joint damage that eventually leads to functional disability causing significant limitations with activities of daily living.
From many pieces of data, it is known that RA is also associated with a reduced life span as a result of its systemic effects. The most significant source for this shortened life span is the cardiovascular complications that can arise, such as heart attack and stroke. Other organ systems such as the lungs, eyes, bone marrow, peripheral nervous system, and others also can be affected and be responsible for excessive morbidity.
In addition to the above-mentioned health complications, RA also results in lost work productivity. In fact, one study showed that more than one-third of patients with RA were work-disabled after having had their disease for more than 10 years.
In recent years, the concept of treat-to-target has become the treatment approach of choice for patients with RA.
The use of the treat-to-target approach has been bolstered by the new 2010 criteria established by the American College of Rheumatology and the European League Against Rheumatism were developed in order to make the diagnosis of earlier disease a priority. The older criteria from 1987 used irreversible x-ray changes as a criterion. By the time x-ray changes occur, it is evident now, the "horse is out of the barn."
In this treat-to-target model, newly diagnosed patients are started on therapy with an intensive regimen of disease modifying anti-rheumatic drugs such as methotrexate along with biologic drugs. The patient is then monitored closely at monthly intervals with adjustments in medications made until the patient is in remission.
There are a number of validated methods for objectively measuring patient progress. These include the Disease Activity Score or DAS 28 and the Clinical Disease Activity Index.
It has been demonstrated that this aggressive approach leads to less in the way of imaging changes seen on both x-ray as well as magnetic resonance imaging (MRI). It is no surprise that patients treated in this fashion reach lower levels of disease activity and have an improved quality of life.
So while the search for a cure remains, the potential for putting a patient with new onset RA into remission is not only a goal, it is a real probability.
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