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Treating inflammatory arthritis early

BMJ 2010; 341 doi: (Published 31 December 2010) Cite this as: BMJ 2010;341:c7384
  1. Chris Deighton, consultant rheumatologist1,
  2. David L Scott, professor2
  1. 1Department of Rheumatology, Royal Derby Hospital, Derby DE22 3NE, UK
  2. 2Department of Rheumatology, King’s College, London School of Medicine, London, UK
  1. chris.deighton{at}

Sustained remission depends on rapid diagnosis and intensive treatment

Inflammatory arthritis is a major healthcare problem. It spans rheumatoid arthritis, seronegative arthritis, and childhood arthritis. Three linked articles outline its clinical and personal effects.1 2 3 Two clinical reviews challenge traditional management approaches, and a patient’s personal testimony highlights the limitations of traditional care. The past decade saw major improvements in managing inflammatory arthritis, captured in guidelines from the National Institute for Health and Clinical Excellence (NICE) and other European and North American groups.4 5 6 7 Despite such advances, far more is needed to overcome the long term effects of inflammatory arthritis on patients and carers.

Rapid diagnosis and treatment are crucial.1 4 5 6 7 Patients need early effective treatment with disease modifying antirheumatic drugs (DMARDs). Traditional, cautious, symptom relieving approaches have become untenable for early inflammatory arthritis. A brief “window of opportunity” exists when effective treatment radically improves long term outcomes.1 4 5 6 7 Delaying the start of DMARDs by more than three months since onset of symptoms perpetuates joint inflammation. The consequences are substantial joint damage and disability and lost independence.1 4 5 6 7 …

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