Rheumatoid arthritis: More aggressive approach improves outlook
Michael E. Weinblatt, MD
Co-director of Clinical Rheumatology, Brigham and Women’s Hospital; Professor of Medicine, Harvard Medical School, Boston, MA
Address: Michael E. Weinblatt, MD, Brigham and Women’s Hospital, Rheumatology-Immunology-Allergy, Arthritis Center, 75 Francis Street, Boston, MA 02115
Medical Grand Rounds articles are based on edited transcripts from Division of Medicine Grand Rounds presentations at The Cleveland Clinic. They are approved by the author but are not peer-reviewed.
The author has indicated that he has received grant or research support from the Abbott, Amgen, Bristol-Myers Squibb, and Millennium companies and has served as a consultant for Abbott, Amgen, Bristol-Myers Squibb, Centocor, Genentech, Merck, Millennium, Roche, TAP, and Wyeth.
This paper discusses therapies that are investigational or are not approved by the US Food and Drug Administration for the use under discussion.
ABSTRACTAs recently as 10 years ago, many patients with rheumatoid arthritis would receive only a nonsteroidal anti-inflammatory drug and low-dose corticosteroids until damage to their joints was documented. Now, despite risks of toxicity and adverse effects, a disease-modifying antirheumatic drug such as methotrexate is given as early as possible to retard disease progression and help prevent new erosions. Other agents can be added to or used in place of methotrexate, such as a biologic response modifier that regulates the proinflammatory cytokine tumor necrosis factor-alpha.