DMARD use in early rheumatoid arthritis. Lessons from observations in patients with established disease 

D. Aletaha, J.S. Smolen

Division of Rheumatology, Department of Internal Medicine Iii, University of Vienna, Austria. 

ABSTRACT
The concept of early and aggressive therapy of rheumatoid arthritis (RA) has been well documented in the past years. It includes immediate DMARD institution after diagnosis, the use of the most effective DMARDs, and rapid switching of regimens if a level of disease activity close to remission is not achieved. In this review we briefly explore to what degree this new concept has been implemented in routine clinical care. Based on an observational dataset comprising 3342 DMARD courses, we present evidence of a change in DMARD patterns in newly diagnosed RA patients towards a higher prescription rate of more aggressive drugs like methotrexate (MTX), as well as a decreasing lag time until MTX was instituted in RA patients over the years. One consequence of recent changes in therapeutic strategies is that comparative analyses of formerly versus recently employed DMARDs will be considerably biased in observational studies. By contrast to changes in DMARD usage, survey data show neither a shortening of referral time nor a change in the approach to diagnose early RA. These data indicate a need for more dissemination of the early arthritis concept. 

Key words
Rheumatoid arthritis, early DMARD therapy.

Please address correspondence to: Daniel Aletaha, MD, Division of Rheumatology, Department of Internal Medicine III, University of Vienna, Vienna General Hospital, Waehringer Guertel 18-20, A-1090 Vienna, Austria. 
E-mail: Daniel.aletaha@akh-wien.ac.at

Clin Exp Rheumatol 2003; 21: (Suppl. 31): S169-S173.
© Copyright Clinical and Experimental Rheumatology 2003.