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Review

Aspects of early arthritis. Biological therapy in early arthritis – overtreatment or the way to go?

Kei Ikeda, Sally Cox and Paul Emery*

Author Affiliations

Academic Unit of Musculoskeletal Disease, Leeds University, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK

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Arthritis Research & Therapy 2007, 9:211  doi:10.1186/ar2177

Published: 24 May 2007

Abstract

The availability of newer, and more expensive, therapies for patients with rheumatoid arthritis has changed treatment beyond recognition. Disease remission is the goal for all new patients. Studies have shown that a combination of tumour necrosis factor (TNF)-blocking drugs and methotrexate produces superior outcomes over monotherapy alone; however, use is limited by cost and potential side-effects. Currently, anti-TNF therapy is normally reserved for patients who have failed traditional disease-modifying anti-rheumatic drugs. The question that remains is whether TNF-blocking drugs are better used if given early; the high direct costs are countered by both direct and indirect savings in healthcare costs from optimal control of disease, and the benefits of early control outweigh the increased risk of infection and malignancy.