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From animal models to new treatments in RA
Rheumatoid arthritis in 2003: where are we now with treatment?
  1. M E Weinblatt
  1. Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA, USA
  1. Correspondence to:
    Dr M E Weinblatt, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA;
    mweinblatt{at}partners.org

https://doi.org/10.1136/ard.62.suppl_2.ii94

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    The treatment of rheumatoid arthritis (RA) has changed considerably over the course of the century. It is difficult to fathom that 100 years ago it was directed towards removing potential sources of infection, with dental extractions and tonsillectomies. Despite appreciable advances, many of the tenets that we currently hold for the management of RA were originally proposed over 70 years ago. Russell Cecil in his Textbook of medicine published in 1931 advocated early treatment of RA “ . . . perhaps the most important factor in prognosis is the application of rational therapy early in the disease.” In 2003, we advocate early intervention with disease modifying treatment. Many of the treatments we use today have been developed over 50 years, including gold salts, sulfasalazine, and corticosteroids.

    In 2003, methotrexate treatment, early institution of disease modifying antirheumatic drugs (DMARDs), combination DMARDs, and the tumour necrosis factor (TNF)α inhibitors generate the greatest amount of interest for the treatment of RA.

    METHOTREXATE

    Despite over 20 years of research and use, there remain problems with methotrexate treatment. Rheumatologists still use doses that are subtherapeutic. In 1990, for 231 patients enrolled in long term prospective studies, the mean dose of methotrexate after 12 months’ of treatment was 10.5 mg a week, and at year 4 it was 12 mg a week.1 At year 7, the mean dose was up to 14 mg a week. These data from more than a decade ago illustrate that an increase in methotrexate dose may be required for clinical response. It is important to note that, in the initial randomised trials of methotrexate, patients were all started on a dose of 7.5 mg a week, which was increased to 15 mg a week on the basis of clinical response.2,3 Most patients had their dose increased to 15 mg …

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