Early Detection and Treatment of Rheumatoid Arthritis

Early Detection and Treatment of Rheumatoid Arthritis

What is RA?^1,2
Rheumatoid Arthritis (RA) is an inflammatory disease of the muscles or joints in your body. RA spreads the inflammation through various tissues, resulting in pain, disability, and mortality. Long-standing inflammation often leads to eroded joints and functional deterioration in the majority of RA patients. RA is a chronic disease, severely affecting patients due to the lack of a cure.

The problem with RA diagnosis¹
Symptoms of early RA are clinically similar to other inflammatory arthritis. As a result, it is difficult to distinguish RA patients from patients suffering from other inflammatory diseases. Patients with early RA end up being classified as undifferentiated arthritis, which delays the correct treatment course for the disease. Early detection and treatment of RA are crucial to stop the progression of the disease; at times, even till the remission stage.

Recently developed diagnostic criteria provides an opportunity to identify and treat patients with early inflammatory arthritis who may progress to RA in the future. The new 2010 criteria classifies more patients at an earlier phase with reasonable discriminative ability.

“The Window Of Opportunity”^1-4
There exists a concept of ‘window of opportunity’ in RA. Early diagnosis is essential for the initiation of treatment and to prevent it from progressing to more severe forms. During this period, treatment is more effective than in the later stages of RA. Many studies have confirmed the existence of this therapeutic window of opportunity and emphasized its long-term outputs. They maintain unity on the opinion that early diagnosis can increase positive therapy outcomes in the future of the RA patient.

The fact that erosive changes occur early in the disease, often in the first year itself has also highlighted the importance of early intervention. A study reported that when induction therapy (i.e., treatment in early diagnosed RA patients) is stopped, patients who have received it begin to clinically resemble those who have not. A rheumatologist is the best person to consult for an accurate diagnosis. He/she will take into account a patient’s medical history, physical examination, and lab tests to make a diagnosis. Identification of all involved joints by precise clinical examination is very important for the diagnosis of RA. 

Studies are in favor of early diagnosis^5-7
Numerous studies conducted have shown that early diagnosis, prompt treatment initiation and early achievement of remission are the major predictors of long-term clinical, functional and radiographic outcomes in RA patients. Data indicates that treatment initiated during the ‘window of opportunity’ i.e., in the first 12 weeks since disease onset, is very effective in controlling disease activity. It has also been established that a delay in the therapy of more than 4 months is the single predictor of remission of RA during therapy.

Early treatment should be encouraged to prevent damage to the inflamed joints in the early phase of RA. The most important aim of RA therapy shouldn’t be rapid alleviation of symptoms but swift blocking of disease progression. Early diagnosis and swift therapy initiation can prevent the development of negative outcomes in this chronic condition.

References:

1. Heidari B. Rheumatoid arthritis: Early diagnosis and treatment outcomes. Caspian J Intern Med. 2011;2(1):161–170.
2. Finckh A, et al. Long-term impact of early treatment on radiographic progression in rheumatoid arthritis: A meta-analysis. Arthritis Rheum. 2006;55(6):864–872.
3. O’Dell JR. Treating rheumatoid arthritis early: a window of opportunity? Arthritis Rheum. 2002;46(2):283–285.
4. Rheumatoid arthritis. Check out. Accessed on: 13 January 2020.
5. Monti S, et al. Rheumatoid arthritis treatment: the earlier the better to prevent joint damage. RMD Open. 2015;1(Suppl 1):e000057.
6. Lard LR, et al. Early versus delayed treatment in patients with recent-onset rheumatoid arthritis: comparison of two cohorts who received different treatment strategies. Am J Med. 2001;111(6):446–451.
7. Schneider M, et al. Rheumatoid arthritis–early diagnosis and disease management. Dtsch Arztebl Int. 2013;110(27-28):477–484.