Treatment strategies are more important than drugs in the management of rheumatoid arthritis

被引:54
作者
Drosos, Alexandros A. [1 ]
Pelechas, Eleftherios [1 ]
Voulgari, Paraskevi V. [1 ]
机构
[1] Univ Ioannina, Med Sch, Dept Internal Med, Rheumatol Clin, GR-45110 Ioannina, Greece
关键词
bDMARDs; csDMARDs; RA; Tight control; Treat to target; tsDMARDs; MODIFYING ANTIRHEUMATIC DRUGS; COBRA COMBINATION THERAPY; DISEASE-ACTIVITY; TRIPLE THERAPY; TIGHT CONTROL; DOUBLE-BLIND; FOLLOW-UP; METHOTREXATE; SULFASALAZINE; OUTCOMES;
D O I
10.1007/s10067-020-05001-x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The treatment of inflammatory arthritides has been changed dramatically in the past two decades with the introduction of the biological (b) disease-modifying anti-rheumatic drugs (DMARDs) as well as the targeting synthetic (ts) DMARDs that can be used as monotherapy or in combination with conventional synthetic (cs) DMARDs. The concept of treat to target (T2T) and tight control monitoring of disease activity represents a therapeutic paradigm of modern rheumatology. In rheumatoid arthritis (RA), this treatment approach has proven to be effective in many clinical trials and is now a well-established approach. The most common treatment strategies rely on the combination of csDMARDs (mainly methotrexate, sulfasalazine and hydroxychloroquine). This comes from different studies which compare the outcomes of combination therapies versus csDMARD monotherapy or versus methotrexate plus biologics in early RA patients. Here, we review the literature of the most important T2T studies for RA patients. The results showed that a tight control strategy appears to be more important than a specific drug to control RA. T2T approach aiming for remission or low disease activity can be achieved in early RA patients using less expensive drugs in comparison to newer drugs and this may need to be recognised in the future recommendations for the management of RA.
引用
收藏
页码:1363 / 1368
页数:6
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