Rheumatoid Arthritis New treatment guidelines call for prevention of cortisone

Targeted treatment instead of long-term cortisone therapy

Rheumatoid arthritis is often associated with the destruction of the affected joints. To prevent this, an early and targeted therapy is necessary. The recent topical guideline for the treatment of the painful disease provides physicians and stakeholders with an overview of treatment options and treatment trends. Among other things, a targeted and early onset care should prevent the long-term use of cortisone.

The German Society for Rheumatology (DGRh) was instrumental in the development of the S2e guideline "Treatment of Rheumatoid Arthritis with Disease Modifying Drugs (DMARDs)". The guideline was made available for free in the "Journal of Rheumatology" online.

In rheumatoid arthritis, the joints are increasingly deformed and completely destroyed in severe disease progression. New treatment approaches without cortisone are to achieve better therapeutic success, which can extend to complete freedom from symptoms. (Picture hriana / fotolia.com)

Over half a million sufferers in Germany

According to the DGRh, around 550,000 adults in Germany suffer from rheumatoid arthritis (also called chronic polyarthritis). Chronic arthritis is thus the most common inflammatory rheumatic disease. It manifests itself by staggering appearance and leads to the affected increasingly joint deformities that can reach to complete destruction.

Disease-modifying drugs instead of cortisone

The new guideline is based on an early-onset therapy with so-called disease-modifying anti-rheumatic drugs (DMARDs), ie disease-modifying drugs, rather than cortisone, which was previously widely used. According to DGRh, these DMARDs can slow the progression of the disease and prevent joint destruction.

Doctor and patient have to work hand in hand

"However, this only succeeds if the patients are examined regularly and if there is no improvement, an early change of the DMARD occurs", reports Professor Dr. med. med. Christoph Fiehn from the Medical Center Baden-Baden and first author of the guideline in a press release. The goal of the treatment remains the achievement of a remission, ie the complete disappearance of the disease activity. If this is not possible, then the next possible lowest disease activity is sought.

Every second patient is treated with high-dose cortisone

Accurate treatment with DMARDs has not yet been widely used, according to the DGRh. Current data indicate that one-third of rheumatoid arthritis patients still have moderate to severe disease activity after two years. In this group, every second is treated with high-dose cortisone. "These patients are at an increased risk for infections, heart disease and osteoporosis," Fiehn explains the side effects of cortisone.

Lots of alternatives available

According to the experts, there are plenty of alternatives to cortisone treatment. Thus, for example, the conventional synthetic DMARD drugs such as methotrexate (MTX) and the biological DMARD have been joined in recent years by two more targeted synthetic DMARDs with the active substances baricitinib and tofacitinib, which can help to combat chronic joint pain.

High drug prices are the reason for hesitation?

"One of the reasons for the rare use are probably the high prices for these drugs," said Professor Fiehn. The new guideline addresses this problem. The experts suggest starting treatment with methotrexate (MTX). According to the professor succeeds in many patients with this drug alone a successful treatment. If MTX is not tolerated, physicians may first prescribe cheap, synthetic DMARDs such as leflunomide or sulfasalazine.

Early controls of the Wiksamkeit

An important aspect to which the guideline points is the early control of the effectiveness of the initial treatment. First inspection dates should already take place after six weeks. Currently, first appointments are scheduled only after twelve weeks. "After six weeks, the tolerability and adherence, ie the adherence of the patient, as well as the correctness of the dosage should be controlled", adds Professor Dr. med. Dr. Hanns-Martin Lorenz, President of the DGRh and Head of the Rheumatology Department at the University Hospital Heidelberg.

Many effects

Through regular checks, physicians can act more effectively on patients and react accordingly. "Depending on the response and prognostic factors, the doctor could then prescribe another DMARD, combine two conventional drugs, or start treatment with either the biological or targeted synthetic DMARD," the experts suggest.

It can be achieved a complete complaint

The experts point out that the procedures of the new guideline can lead to a permanent complaint-free status in some patients. In such patients, the drug can even be lowered. However, this is only possible if the patients no longer take cortisone and have been symptom-free for six months. (Vb)