Treatment of early rheumatoid arthritis

Abstract

Recent advances in the understanding of the pathophysiology, aggressive treatment, and early detection of rheumatoid arthritis (RA) have changed the clinical, pathologic, and functional outcomes in patients with RA. Early aggressive treatment of RA has now become the norm in clinical practice rather than the use of the traditional pyramid approach of the last half of the twentieth century. Early treatment with monotherapy of traditional disease-modifying antirheumatic drugs (DMARDs) or biologics, combination traditional DMARD therapy and, especially, combination of biologic therapy and methotrexate, have revolutionized the treatment of RA, producing significant improvement in clinical, radiographic, and functional outcomes not seen previously. For the individual patient, we still cannot determine which medication or combination of medications will give the most complete response. There have been a number of recent, well-designed clinical trials that have tried to answer this question. Herein we review the evidence-based medicine that addresses these issues.

Geraniol Suppresses Oxidative Stress, Inflammation, and Interstitial Collagenase to Protect against Inflammatory Arthritis

“…Even with the advancement in the treatment, the target of the therapy is still not fully achieved as the etiology and pathophysiology of the disease are not fully understood . Currently, the drug therapy used for the treatment of IA is an empirical therapy, which is not suitable for every patient, which demands the search for new, effective, and most suitable drug …”

“…10 Currently, the drug therapy used for the treatment of IA is an empirical therapy, which is not suitable for every patient, which demands the search for new, effective, and most suitable drug. 11 In this study, we have evaluated geraniol (GER), a monoterpene alcohol present in essential oils of various plants including Cinnamomum tenuipilum and Valeriana officinalis, 12 for the prevention/treatment of IA. Previously, GER has shown its anticancer, 13 anti-inflammatory, 14 antioxidative, 15 and antimicrobial effects.…”

“… 10 Currently, the drug therapy used for the treatment of IA is an empirical therapy, which is not suitable for every patient, which demands the search for new, effective, and most suitable drug. 11 …”

Determining Best Practices in Early Rheumatoid Arthritis by Comparing Differences in Treatment at Sites in the Canadian Early Arthritis Cohort

“…early, aggressive, tightly controlled, goal-targeted treatments with disease-modifying antirheumatic drugs (DMARD) to inhibit disease progression and promote optimal outcomes, thus making remission a realistic treatment goal, especially for early rheumatoid arthritis (ERA) 3,6,7,8,9,10,11 . Despite this general consensus, there currently is a lack of agreement on the best DMARD or DMARD combination, dose, or route to use and the best time to adjust treatment.…”