Early Diagnosis, Early Treatment Is Key

In 2016, the European League Against Rheumatism (EULAR) updated its recommendations for early referral to a rheumatologist: Patients should seek help within six weeks of symptom onset, and early management should be directed by a rheumatologist. The recommendations also suggest patients at risk for chronic arthritis should begin a course of disease-modifying antirheumatic drugs (DMARDs) within three months after symptoms appear.

Early and aggressive RA treatment is recommended by all the scientific and medical societies all over the world, stresses Cristiano Zerbini, MD, a rheumatologist and the director of the Centro Paulista de Investigação Clinica in São Paulo, Brazil, whose research team found in results published in Osteoporosis International that “treatment with biologic drugs is associated with the decrease in bone loss. Studies with anti-TNF blocking agents show preservation or increase in spine and hip BMD [bone mineral density] and also a better profile of bone markers.”

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Zerbini explains that early treatment that stops disease activity also stops joint and bone destruction. “You may compare the inflammatory process in the beginning of the disease to a bonfire that may become a [larger] fire, destroying the joint and adjacent bone if [it’s] not eliminated by treatment as soon as possible,” he says. The bottom line: Do not delay treatment.

Zerbini adds, “The active disease leads to a continuous loss of bone and consequently to osteoporosis, leaving the patient with a high probability of a low-trauma fracture. The pain and deformity prevent the ability to exercise, which contributes to additional loss of bone.”