מתוך medicontext.co.il
NEW YORK (Reuters Health) – Updated guidelines for the management of rheumatoid arthritis (RA), presented by the American College of Rheumatology (ACR), emphasize the value of early diagnosis and treatment in preventing joint damage. They are published in the February issue of Arthritis and Rheumatism.
"The reason the guidelines have been updated now is that the last 2 or 3 years have seen several new therapeutic interventions introduced to the market that were not available in 1996," Dr. Stanley Cohen, of the University of Texas Southwestern Medical School in Dallas, told Reuters Health. "There's a whole world of new data from clinical trials and further updates of epidemiological studies showing that RA patients need to be treated earlier and more aggressively."
The ACR recommends that initial treatment should be chosen based on prognosis. Earlier age of RA onset, high rheumatoid factor titer, elevated erythrocyte sedimentation rate, swelling of more than 20 joints, or extraarticular manifestations suggest a poor outlook. For such patients, aggressive treatment with disease modifying antirheumatic drugs (DMARDs) is recommended as soon as the diagnosis is made.
"The management of RA is an iterative process, and patients should be periodically reassessed for evidence of disease activity or progression and for any toxic effects of the treatment regimen," the authors write.
New medications approved by the US Food and Drug Administration since the ACR last issued guidelines 5 years ago include two anti-tumor necrosis factor-alpha agents, etanercept and infliximab. Also, anakinra, a recombinant human form of interleukin-1 receptor antagonist, and leflunomide, a DMARD, were recently approved.
"Another new treatment modification has been the advent of using these drugs in combination," Dr. Cohen added. "For example, we may give a patient a biological agent plus a DMARD or two different DMARDs."
He doesn't foresee the new guidelines as being controversial, either among healthcare providers or third party payers. "The insurers are already funding the TNF inhibitors and other new biologics," he said. "They basically want to know what is the right approach for treating these patients, and the guidelines set out the parameters for how medications should be used.
e-Med Tools
קצר קולע וממוקד
e-Med סמינרים
אי-מד תחקירים
Medscape Tools
Journal Club
מרכזי מידע ושירות
Facebook
מידע למפרסם
מאגר תרופות
מאגר אנשי המקצוע
אינדקס שימושי
חדשות משה"ב
eMed HealthClub
מחקרים קליניים
השאירו תגובה
רוצה להצטרף לדיון?תרגישו חופשי לתרום!