Over the years, the recommendation for initial rheumatoid arthritis treatment has shifted from conservative treatment to aggressive treatment. Patients are sometimes timid about treatment and wonder when it becomes essential to be aggressive about treatment. According to a report on MDConsult.com, an analysis of results from the DEO19 trial suggests that early, aggressive treatment is best to prevent irreversible joint damage. DEO19 was a randomized, double-blind study that compared patients treated with methotrexate plus either Humira (adalimumb) or placebo for one year. After the year was up, all patients in the study were eligible for treatment with Humira for 9 more years.
Delaying treatment of long-standing rheumatoid arthritis (average disease duration was 11 years when the study began) with Humira by just one year was associated with greater joint space narrowing (i.e., loss of cartilage) a decade later. Researchers were surprised that the placebo group never caught up to patients who were treated with Humira from the start of the study. Increased joint space narrowing can decrease quality of life so the findings are significant. Researchers concluded that more studies are needed to determine which patients should be treated when. Humira is not suitable for all patients. But for those who are good candidates for the drug, this particular study gives a green light to treating early.
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