The therapeutic approach of early intervention for rheumatoid arthritis: what is the evidence?

Objective. The concepts of early intervention and early arthritis clinics f or the management of rheumatoid arthritis (RA) were introduced almost a dec ade ago. The evidence for these is diverse and the best therapeutic approac h remains vehemently debated. This review addresses these issues, Methods. The MEDLINE database was searched to identify relevant papers sati sfying inclusion criteria for disease duration and no previous use of disea se-modifying anti-rheumatic drugs (DMARDs). Where possible. evidence was ob tained from randomized controlled trials. We selected the most relevant top ics to best justify early therapeutic intervention in RA. Results. The benefit of DMARDs over placebo and delayed therapy is unquesti onable from the studies presented, with reduction in bone damage and preser vation of function. Through prevention of disability, early treatment shoul d be the most cost-effective approach. The evidence presented supports the use of DMARDs when the diagnosis of RA is first made. Delay in treatment ma y result in irreversible damage. There is insufficient evidence to recommen d combination therapy for all patients at disease onset. Further research i nto newer therapies is required before their routine first-line use is reco mmended. Conclusions. Early therapeutic intervention in RA reduces long-term disabil ity and joint damage. Optimal management appears to be the early identifica tion of non-responders and targeted combination therapy. Biological therapi es have the potential to revolutionize the treatment of early RA.