The need for early diagnosis and intervention in rheumatoid arthritis

Abstract

Until the mid-1980s, the general approach to the treatment of rheumatoid arthritis was to delay the instigation of disease-modifying therapy until the joint erosions became apparent on imaging studies. It was thought that the disease could be controlled with bed rest and aspirin or non-steroidal anti-inflammatory drugs (NSAIDs). However, it began to be realised that any short-term efficacy of these treatments did not translate into long-term disease control. Furthermore, delays in instituting more aggressive treatment with DMARDs and immunosuppressive therapies, rather than protecting patients against their unwanted effect were in fact contributing to increased morbidity and mortality (Pincus and Callahan 1986) in a disease that is chronic and, if not adequately treated, almost always progressive.