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Review

Aspects of early arthritis. Traditional DMARD therapy: is it sufficient?

Klaus P Machold*, Valerie PK Nell, Tanja A Stamm and Josef S Smolen

Author affiliations

Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria

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Citation and License

Arthritis Research & Therapy 2006, 8:211  doi:10.1186/ar1966

Published: 15 May 2006

Abstract

There is increasing evidence for beneficial effects of early DMARD (disease-modifying antirheumatic drug) therapy over delayed treatment in patients who present with arthritis of recent onset. However, no universal consensus exists concerning the choice of initial drug or whether single drugs or combinations should be given as initial treatments. Recent studies have focused on the benefits of various strategies in which treatments were tailored to achieve low levels of disease activity, as assessed using validated response criteria. These studies demonstrated superiority of 'aggressive' over 'conventional' approaches. Whether the inclusion of tumour necrosis factor antagonists or other biologic targeted therapies in such strategies confers additional benefits in terms of improved long-term outcomes must be clarified by further studies. Assessment of risks in the individual patient, allowing individual 'tailoring' of the initial treatment, would be desirable.