Rheumatology Advance Access originally published online on March 14, 2006
Rheumatology 2006 45(5):497-499; doi:10.1093/rheumatology/kel014
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
EDITORIAL |
Should aggressive therapy for rheumatoid arthritis require early use of weekly low-dose methotrexate, as the first disease-modifying anti-rheumatic drug in most patients?
1 Vanderbilt University, Nashville, Tennessee, USA and 2 Jyvaskyla Central Hospital, Jyvaskyla, Finland
Correspondence to: T. Pincus, Division of Rheumatology and Immunology, Vanderbilt University School of Medicine, 203 Oxford House, Box 5, Nashville, TN 37232–4500, USA. E-mail: t.pincus@vanderbilt.edu
| The first 150 words of the full text of this article appear below. |
Therapy for rheumatoid arthritis (RA) has evolved substantially over the last two decades. During the 1980s it was recognized that most patients experienced poor outcomes over 10–20 yr, including radiographic progression [1], severe functional declines [2, 3], work disability [2, 4] and premature mortality [2]. During the 1990s, calls for an aggressive strategy [5–10], led to the introduction of disease-modifying anti-rheumatic drugs (DMARDs) in early RA, particularly weekly low-dose methotrexate [11, 12], often in combination [10, 13], to prevent long-term damage. Weekly low-dose methotrexate had greater efficacy [11, 12], lower toxicity [14, 15] and considerably greater long-term continuation than previously available DMARDs [16]. During the first years of the present century, evidence of reduced mortality outcomes [17, 18] and considerably better