Ulusal Romatoloji Dergisi / Journal of Turkish Society for Rheumatology
p-ISSN: 2651-2653
e-ISSN: 2651-2661
Haner Direskeneli
2019 Volume 11
Deomed Yayıncılık
Volume 4, Issue 2, December 2012
Page(s): 59-67
Received: February 22, 2012; Accepted: August 20, 2012; Published online: September 26, 2012
doi:10.2399/raed.12.012; Copyright © 2012 the Society for Education and Reserach in Rheumatology (RAED), Turkey
Early treatment in rheumatoid arthritis
Reşit Yıldırım, Yusuf Yazıcı (E-mail)
NYU Langone Medical Center Hospital for Joint Diseases, New York, NY, 10016, USA
Rheumatoid arthritis (RA) is an autoimmune disease of unknown aetiology which primarily targets the synovial tissue, cartilage and bone. In the last two decades, it is well established that structural cartilage damage also may occur before it is visible on radiograph, so new terms, “early arthritis” in 1990s and “very early synovitis or arthritis” in 2000s, were defined. However, patients presenting with early arthritis evoke new problems in predicting progression to RA in the long-term. Definable risk factors, such high titers of anti-CCP and/or RF (rheumatoid factor) at presentation, history of smoking may assist in classification. The goal in RA is based on early and agressive therapeutic management to prevent functional disablity over long-term, even in patients presenting with undifferentiated arthritis or highly suspected RA. Methotrexate (MTX) is the anchor drug in RA due to its long-term safety use, low toxicity profile and ability of combining with biologics. In addition to MTX, prednisone, at high or low doses, is also recommended to control the symptoms in short-term as well as in long term. In case of inadequate response despite primary therapy (MTX+prednisone) within the first 3 to 6 months, combination particularly with one of biologics or DMARD’s (leflunomide, sulfasalazine, hydroxycloroquine) other than MTX should be considered as the second phase to achieve the target (remission or low disease activity). In the cases of low clinical response to the second phase of therapeutic regimen (biologics+MTX), patients should be switched to another biologic until the time to an optimal outcome.
Keywords: Rheumatoid artrhritis, early synovitis, early treatment, methotrexate, biologics
RAED Dergisi / RAED Journal

Türkiye Romatoloji Derneği (TRD) yayın organıdır. Deomed Yayıncılık tarafından yayımlanmaktadır. / Official Publication of the Rheumatology Society of Turkey (TRD). Published by Deomed Publishing. Copyright © 2019, TRD.
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RAED Dergisi çevrimiçi (online) sürümünde yayımlanan akademik içeriğin kullanım hakları, ilgili içerikte tersi belirtilmediği sürece Deomed Yayıncılık tarafından Creative Commons Attribution-NoCommercial-NoDerivs 3.0 Unported (CC BY-NC-ND3.0) lisansı aracılığıyla bedelsiz sunulmaktadır. / Except where otherwise noted, academic content of this online version of the journal by Deomed Publishing is licensed under the terms of Creative Commons Attribution-NoCommercial-NoDerivs 3.0 Unported (CC BY-NC-ND3.0) License.