I Have Just Been Diagnosed With Rheumatoid Arthritis. My Doctor Wants To Wait To Treat. What Should I Do?

Twenty five years ago, the therapeutic options for rheumatoid arthritis (RA) were greatly limited. High doses of corticosteroids were often administered over a prolonged period of time. And gold salts were still being injected for people with severe disease.

Likewise, drugs such as penicillamine and hydroxychloroquine (Plaquenil) were still being used for many patients despite the presence of severe disease. Strong immunosuppressive drugs such as cyclophosphamide (Cytoxan), azathioprine (Imuran), and cyclosporine (Sandimmune) were often employed late in the course of treatment.

This was done because there were no other options.

Today, the whole approach to the treatment of RA has changed. Therapy for RA should be immediate and aggressive, aimed at improving the signs and symptoms of the disease and avoiding disability.

Although there is no cure for RA, early diagnosis and treatment are critical to limit inflammation and prevent joint damage. The treatment approach to RA should be immediate and aggressive, with the aim of improving the signs and symptoms of the disease and preventing disability.

According to the American College of Rheumatology, the goal of treatment is the induction and maintenance of remission, leading to an improved quality of life. What is not mentioned is that early aggressive treatment also may forestall the onset of crippling, deformity, as well as early death from the cardiovascular complications due to RA.

The earlier the treatment of RA is initiated, the better will be the overall outcome. In a trial that compared the initiation of disease-modifying anti-rheumatic drugs (DMARDs) within 15 days of the diagnosis of RA with delayed treatment (approximately 120 days following diagnosis), the early treatment group had less radiological joint damage after 2 years than the delayed-treatment. Delayed treatment can be associated with loss of joint structural integrity resulting in physical functional decline, work impairment, and economic loss.

Of more immediate concern is the marked increased risk of cardiovascular mortality- death from heart attack and stroke- that can accompany the persistent chronic inflammation of RA. Some rheumatologists and patients may argue that their disease isn’t that bad... that they can live with it.

The unfortunate reality is that although the disease may not be explosive or severe, even low grade chronic disease can cause irreversible damage over an extended period of time.

While rheumatologists may quibble over the best course of action to follow- either institution of triple DMARD therapy or rapid institution of biologic drugs- most agree that rapid institution of treatment with the aim of remission is advisable.

The trend today is to use biologic drugs because of their targeted mode of action as well as their extreme effectiveness in inducing remission.

If your rheumatologist dawdles around and is not aggressive in his or her approach to your condition, get another opinion.

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