kageyd
01-10-2010, 01:53 PM
A large number of Dutch physicians conducted a multiyear study on over 500 newly diagnosed RA patients. The full results are reported in The Annals of Internal Medicine, 2007 (easily found, free, in Google Scholar), and here is the URL in which the journal presents a full editorial evaluating the study. Below the URL is a condensation of the conclusions. In short, motivated physicians who feel free to use drugs and/or combinations of drugs, with changes as they see fit, have about equal success over several years no matter which pattern they start with. In other words, no one therapy is better than another over time. What is most important is the active involvement and engagement of the attending physician, and the willingness to change plans depending upon the patient's results.
I have often said on this forum how absolutely critical I believe it is to have a motivated physician, preferably a rheumatologist, who is up on the most current research in charge of the treatment of RA, and this large study very much supports that position.
I suggest that a reading of the full editorial would be helpful especially to newcomers, but to those relatively recently diagnosed as well. This study seems to be a companion to the one that Crimson just posted today. In the Netherlands, the study of RA is obviously very much a priority.
Kageyd
URL of editorial in Annals of Internal Medicine:
http://www.annals.org/content/146/6/I-63.full
Condensation of key part of that editorial:
What are the take-to-the-clinic messages of this study,
and how do we integrate this new information to provide
optimal care for all patients with newly diagnosed RA?
According to the report of the first-year results, patients
receiving combination therapy (methotrexate either with
sulfasalazine and prednisolone or with infliximab) had the
best results in the least amount of time (16). This finding
corroborates the findings of many other studies in early
RA, which clearly show that when studying groups of pa-
tients, those who receive more drugs (combinations of con-
ventional DMARDs or biologicals) do better in the short-
term (4 –10, 13–15). However, the 2-year BeSt results, as
reported here, underscore the need to individualize ther-
apy. Treating physicians titrated and changed drugs in in-
dividual patients and achieved excellent control while using
a large variety and combination of drugs. Overall, the key
finding of the 2-year results is that if clinicians have
the flexibility to change therapy and have a clear treatment
goal, all patients achieve similar disease control, regardless
of their originally assigned treatment.
I have often said on this forum how absolutely critical I believe it is to have a motivated physician, preferably a rheumatologist, who is up on the most current research in charge of the treatment of RA, and this large study very much supports that position.
I suggest that a reading of the full editorial would be helpful especially to newcomers, but to those relatively recently diagnosed as well. This study seems to be a companion to the one that Crimson just posted today. In the Netherlands, the study of RA is obviously very much a priority.
Kageyd
URL of editorial in Annals of Internal Medicine:
http://www.annals.org/content/146/6/I-63.full
Condensation of key part of that editorial:
What are the take-to-the-clinic messages of this study,
and how do we integrate this new information to provide
optimal care for all patients with newly diagnosed RA?
According to the report of the first-year results, patients
receiving combination therapy (methotrexate either with
sulfasalazine and prednisolone or with infliximab) had the
best results in the least amount of time (16). This finding
corroborates the findings of many other studies in early
RA, which clearly show that when studying groups of pa-
tients, those who receive more drugs (combinations of con-
ventional DMARDs or biologicals) do better in the short-
term (4 –10, 13–15). However, the 2-year BeSt results, as
reported here, underscore the need to individualize ther-
apy. Treating physicians titrated and changed drugs in in-
dividual patients and achieved excellent control while using
a large variety and combination of drugs. Overall, the key
finding of the 2-year results is that if clinicians have
the flexibility to change therapy and have a clear treatment
goal, all patients achieve similar disease control, regardless
of their originally assigned treatment.