Arthritis: A new directive calls for early controls

Mar. July 11, 2018

Early and targeted therapy can often prevent joint destruction in people with rheumatoid arthritis. The German Rheumatology Society (HRG) has issued a new guideline on how treatment should be performed despite limited resources. Particularly important are the first follow-up appointments after six weeks and targeted treatment instead of long-term corticosteroid therapy.

For the treatment of rheumatoid arthritis, treatment should be as rapid as possible, according to the recommendations of the HRMG at best within three months of the onset of symptoms. The updated directive now provides for a first check after the start of treatment after six weeks, instead of 12 weeks as before. The goal of treatment remains to achieve remission, that is, the complete disappearance of the disease activity or, if this is not possible, the patient will not be able to do so. disease activity as low as possible. Disease-modifying antirheumatic drugs (DMARDs), disease-modifying drugs: They can slow the progression of the disease and prevent joint destruction. "However, this only succeeds if patients are examined regularly and if there is no improvement, an early change in the DMARD occurs," says Professor Dr. med. med. Christoph Fiehn from the Baden-Baden Medical Center, first author of the directive. Treatment should begin with the active ingredient methotrexate (MTX). "Many patients manage to control the disease with MTX alone," says Professor Fiehn. For patients who do not tolerate MTX, physicians could first use cheap synthetic DMARDs such as leflunomide or sulfasalazine.

An important goal remains the early lowering of the cortisone dose, ideally until the full stop. According to experts, many doctors still prescribe low-dose cortisone. Fiehn warns: "There is no evidence that low-dose cortisone is safe or has an added value in optimized DMARD therapy."

NK

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