Tight control” in the management of RA | Arthritis Information

 

Many, if not all, readers will have heard of diabetes, a condition in which levels of glucose in the bloodstream are too high because the cells of body tissues are not able to absorb it as efficiently as they should under the influence of the hormone insulin. For many decades now we have known that diabetics need an appropriate diet and treatment to try and lower the blood glucose levels. However, for a long time it was not known how important it was to try and control the blood glucose to the extent that it remained within the normal, or near normal, range. It was believed that normalisation of glucose concentrations might reduce some of the long-term problems associated with diabetes, such as nerve and blood vessel damage. However, it has only been relatively recently that it has been possible to establish that this is indeed the case; so called “tight-control” of glucose levels leads to better long-term outcomes for diabetics. In just the same way, it has emerged in recent years that tight control of inflammation in rheumatoid arthritis (RA) at every stage of the condition also leads to better long term outcomes.

Early identification of patients with RA and in particular, those likely to suffer from more rapid joint damage, is important because of the likely benefit of early intervention with disease-modifying anti-rheumatic drugs (DMARDs) or biologic therapies. As appreciation of the gravity of the social and economic burden imposed by RA has grown, so has the recognition that more favourable clinical outcomes are achieved when inflammation is optimally suppressed. In particular, there is now compelling evidence that intervention with DMARDs early in the course of disease results in improved remission rates, magnitude of clinical benefit, and slowing of damage to joints. In addition, the armamentarium of therapeutics has grown. Of these, biologic therapeutics targeting TNF-α, particularly when used in combination with oral methotrexate, have enjoyed considerable success in suppressing inflammation and markedly inhibiting the progression of joint damage previously thought to be an unavoidable characteristic of RA.

http://www.rheumatoid.org.uk/article.php?article_id=578[QUOTE=Lynn49]...so has the recognition that more favourable clinical outcomes are achieved when inflammation is optimally suppressed.... intervention with DMARDs early in the course of disease results in improved remission rates, magnitude of clinical benefit, and slowing of damage to joints. In addition, the armamentarium of therapeutics has grown.
... suppressing inflammation and markedly inhibiting the progression of joint damage previously thought to be an unavoidable characteristic of RA. excellent post Lynn, this is one of the best articles I have read on control of RA, tools used to determine disease level, studies of outcomes with measured control, consequences...

From the article;

The patients assigned to the “tight control” arm of the trial were treated with standard oral disease modifying anti-rheumatic drugs (DMARDs) with the rapid addition of additional DMARDs if the DAS failed to improve by a set amount, together with steroid joint injections and/or intramuscular steroid as required. After a year, remission rates were significantly greater in the intensive therapy group at 65% vs 16%. Similarly, X-ray outcomes were superior in the intensive therapy group. Interestingly, when the group treated with a “tight control” protocol reverted to standard care after 18 months, the initial benefits were lost.

This pretty much says it all as far as control goes.

I want to add this to those who are willing to listen;  Two years ago, I had a normal cardiac catherization.  They looked at the aortic valve and saw I had mild regurgitation with no blockages and the valve looked good (which I assume meant no stenosis).  My control of my RA for the last 2 years has been a roller coaster of on and off meds with swings of great control to not good at all.  As anyone who has followed the thread on my heart knows, my aortic valve now needs replacing.  My doctors were surprised, to say the least, about how fast the progression from mild regurgitation to severe stenosis has been. 

The reason?  RA and the lack of control of the inflammation.  No doubt.

I hope this article stays on the top for a good while and everyone in this forum takes the time to read and re-read and digest the information it offers!

waddie2009-08-01 11:20:04[QUOTE=waddie] Lynn, this is one of the best articles I have read on control of RA, tools used to determine disease level, studies of outcomes with measured control, consequences...

From the article;

The patients assigned to the “tight control” arm of the trial were treated with standard oral disease modifying anti-rheumatic drugs (DMARDs) with the rapid addition of additional DMARDs if the DAS failed to improve by a set amount, together with steroid joint injections and/or intramuscular steroid as required. After a year, remission rates were significantly greater in the intensive therapy group at 65% vs 16%. Similarly, X-ray outcomes were superior in the intensive therapy group. Interestingly, when the group treated with a “tight control” protocol reverted to standard care after 18 months, the initial benefits were lost.

This pretty much says it all as far as control goes.

I want to add this to those who are willing to listen;  Two years ago, I had a normal cardiac catherization.  They looked at the aortic valve and saw I had mild regurgitation with no blockages and the valve looked good (which I assume meant no stenosis).  My control of my RA for the last 2 years has been a roller coaster of on and off meds with swings of great control to not good at all.  As anyone who has followed the thread on my heart knows, my aortic valve now needs replacing.  My doctors were surprised, to say the least, about how fast the progression from mild regurgitation to severe stenosis has been. 

The reason?  RA and the lack of control of the inflammation.  No doubt.

I hope this article stays on the top for a good while and everyone in this forum takes the time to read and re-read and digest the information it offers!

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