Rheumatoid Arthritis: Can the Long-Term Outcome Be Altered?

Abstract

Although several agents (for example, intramuscularly administered gold, auranofin, D-penicillamine, hydroxychloroquine, and methotrexate) are of clinical benefit in the management of rheumatoid arthritis (RA), their effect on the long-term outcome of the disease is controversial. Assessment of the influence of therapeutic interventions in RA is difficult because the natural history of the disease remains poorly defined and unpredictable, and neither the traditional clinical and laboratory measurements of inflammation nor radiographic analyses of progression of joint destruction provide an accurate estimate of the long-term outcome of RA. Furthermore, there is little evidence that second-line agents yield benefits beyond 3 years. Therefore, adequately tested comprehensive measures should be used in large, long-term, multicenter controlled clinical trials to determine whether the long-term outcome of RA can be altered.

Newly diagnosed rheumatoid arthritis

“…Using standard treatment (bed rest and aspirin) in the 1930s, 1940s, and 1950s, Short and colleagues presided over a relentless progression of disease. 15 In the subsequent decade, modern treatment consisting of gold and corticosteroids from a large metropolitan centre in New York City produced undeniable progression of disease. 16 "The long term outcome for patients with RA has changed enormously"…”

Arthritis in the Elderly: Is it Degenerative or Rheumatoid?

“…Active and assistive exercise preserves and restores joint motion and muscle strength. Drugs are the mainstay of treatment for disease control, although their effect on long-term outcome has been questioned (22,23). Aspirin is the most useful drug in treatment, as 50% of patients will respond to it alone; the remainder may require a trial of one of the NSAID's.…”