Therapeutic Strategies in Rheumatology PDF Free Download
Rheumatoid arthritis (RA) is the most common type of inflammatory arthritis, affecting about 1% of the population. It typically presents between the ages of 40 and 50 years, affecting twice as many women as men. Untreated, it results in joint destruction, functional impairment and increased mortality . In recent years, with the availability of effective therapies and the use of early intensive treatment strategies, disease outcomes have improved considerably [2–6]. Studies confirm that all therapies – monotherapy, combination therapies with diseasemodifying antirheumatic drugs (DMARDs) and the newer biological agents – work better in early disease than in established RA. Further improvements are achieved with regular monitoring of disease activity and escalation of therapy if optimal disease control is not obtained. The goal of treatment is no longer simply symptom control but early suppression of inflammation and aiming for remission (a low disease activity state that, if sustained, is neither damaging nor disabling) .
Although rheumatologists agree that these patients should be seen and treated at the earliest opportunity and optimal disease control should be achieved, a number of issues remain. These include the choice of initial therapy, patient criteria for combination therapy and the use and timing of the newer biological agents . Treating patients with early undifferentiated inflammatory arthritis and preventing the development of RA is another therapeutic strategy under investigation. THE RATIONALE FOR EARLY THERAPY  Joint damage occurs early in the inflammatory process. There is evidence that radiographic damage , loss of bone mineral density [11–13] and loss of function  occur early. Radiological outcome studies have shown that 70% of patients with recent-onset RA develop bone erosions within the first 3 years . Furthermore, within 3 months of disease onset, 25% of patients have erosions evident on radiographs . Presence of these early erosions predicts the future development of radiographic lesions. Newer imaging techniques, such as magnetic resonance imaging (MRI) and ultrasound, have confirmed evidence of damage within weeks of onset of symptoms [17, 18]. These lesions also correlate reliably with later radiographic erosions .