My Rheumatoid Arthritis Is Not So Bad Now. How Long Should I Wait To Treat It?

For people with RA, “watchful waiting” is not an appropriate treatment strategy. Medical studies reveal some important facts that demonstrate why early treatment of RA is necessary:

  • The majority of joint destruction occurs in the first two years after disease onset.
  • Significant joint destruction can occur even when the joint is not painful.
  • Joint damage is irreversible—it does not “improve” significantly with treatment.
  • Patients who are treated early feel better than those who delay treatment for one year.
  • Patients who are treated early tend to have a more robust response to medications than those who wait for treatment.

Not all early treatments are the same, however. A Dutch study showed that the type of early treatment you receive matters. In this study, investigators compared patients with RA who were treated with therapies such as nonsteroidal anti-inflammatory drugs (NSAIDs) or methotrexate alone to other patients who were treated with combinations of methotrexate and infliximab, a tumor necrosis factor (TNF) blocker. They found that the more aggressive combination (methotrexate/infliximab) resulted in less joint erosion and improved function than in patients treated with monotherapy (a single drug). Some patients in this study actually experienced a remission of their disease; that is, after the aggressive combination treatment, they had no signs or symptoms of RA. How long these remissions will last is unknown.

While it's ideal to initiate treatment as early as possible, aggressive treatment throughout the course of the disease is essential, say experts. Even if you've passed the two-year mark and have sustained some joint damage through a lack of treatment or treatment that wasn't completely successful, you can still benefit from aggressive therapy. While some joints may have been damaged, others can be preserved by treating your RA appropriately. Further, the burden of inflammation, which results in non-joint-related RA difficulties such as an increased risk for coronary artery disease and stroke, can be improved by therapy. A decreased risk for these complications can be seen, even years after the start of RA symptoms.

While it's ideal to initiate treatment as early as possible, aggressive treatment throughout the course of the disease is essential. Even if you've passed the two-year mark and have sustained some joint damage through a lack of treatment or treatment that wasn't completely successful, you can still benefit from aggressive therapy.

Coronary artery disease

A narrowing of the coronary arteries that results in inadequate blood flow to the heart.