Article information
Resumen
Durante las dos últimas décadas ha habido un cambio en el paradigma de tratamiento de la artritis reumatoide y hay consenso en que la terapia debe iniciarse lo más tempranamente posible con el objeto de controlar la inflamación articular, retrasar el daño estructural y preservar la capacidad funcional y la calidad de vida. El objetivo es lograr la remisión de la enfermedad. Sin embargo, se desconoce cuál es la estrategia terapéutica óptima.
Son indiscutibles las ventajas del tratamiento temprano con fármacos antirreumáticos modificadores de la enfermedad si se compara con el retraso en el inicio del tratamiento. Además, la terapia en combinación con dosis moderadas o altas de esteroides y combinaciones de metotrexato con antagonistas del factor de necrosis tumoral es más eficaz que la monoterapia.
Presentamos una revisión de los distintos tratamientos estudiados en artritis reumatoide precoz.
Palabras clave:
Artritis reumatoide precoz
Artritis de reciente comienzo
Abstract
In the last two decades, there has been a shift in the paradigm of RA treatment and there is consensus for earlier interventions to control inflammation, retard the progression of structural damage and preserve function and quality of life. Thus, the final objective is to obtain the remission of disease. However, the optimal therapeutic strategy remains unknown.
The advantage of treating RA early with DMARD therapy compared to its delayed institution is clear. Moreover, combination therapy including moderate to high doses of glucocorticoids and combinations of methotrexate with tumour necrosis factor blockers are more effective than monotherapies.
We review here the different treatments strategies studied in early RA.
Key words:
Rheumatoid early arthritis
Recent ouset arthritis
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Bibliografía
[1.]
T. Mottonen, P. Hannonen, M. Leirisalo-Repo, M. Nissila, H. Kautiainen, M. Korpela, et al.
Comparison of combination therapy with single-drug therapy in early rheumatoid arthritis: a randomised trial. FIN-RACo trial group.
Lancet, 353 (1999), pp. 1568-1573
[2.]
V.P. Nell, K.P. Machold, G. Eberl, T.A. Stamm, M. Uffmann, J.S. Smolen.
Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis.
Rheumatology (Oxford), 43 (2004), pp. 906-914
[3.]
T.T. Mottonen, P.J. Hannonen, M. Boers.
Combination DMARD therapy including corticosteroids in early rheumatoid arthritis.
Clin Exp Rheumatol, 17 (1999), pp. S59-S65
[4.]
L. Gossec, M. Dougados, P. Goupille, A. Cantagrel, J. Sibilia, O. Meyer, et al.
Prognostic factors for remission in early rheumatoid arthritis: a multiparameter prospective study.
Ann Rheum Dis, 63 (2004), pp. 675-680
[5.]
F.C. Arnett, S.M. Edworthy, D.A. Bloch, D.J. McShane, J.F. Fries, N.S. Cooper, et al.
The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis.
Arthritis Rheum, 31 (1988), pp. 315-324
[6.]
K.P. Machold, T.A. Stamm, G.J. Eberl, V.K. Nell, A. Dunky, M. Uffmann, et al.
Very recent onset arthritis-clinical, laboratory, and radiological findings during the first year of disease.
J Rheumatol, 29 (2002), pp. 2278-2287
[7.]
B.J. Harrison, D.P. Symmons, E.M. Barrett, A.J. Silman.
The performance of the 1987 ARA classification criteria for rheumatoid arthritis in a population based cohort of patients with early inflammatory polyarthritis. American Rheumatism Association.
J Rheumatol, 25 (1998), pp. 2324-2330
[8.]
N. Wiles, D.P. Symmons, B. Harrison, E. Barrett, J.H. Barrett, D.G. Scott, et al.
Estimating the incidence of rheumatoid arthritis: trying to hit a moving target?.
Arthritis Rheum, 42 (1999), pp. 1339-1346
[9.]
M. Green, H. Marzo-Ortega, D. McGonagle, R. Wakefield, S. Proudman, P. Conaghan, et al.
Persistence of mild, early inflammatory arthritis: the importance of disease duration, rheumatoid factor, and the shared epitope.
Arthritis Rheum, 42 (1999), pp. 2184-2188
[10.]
N. Wiles, G. Dunn, E. Barrett, A. Silman, D. Symmons.
Associations between demographic and disease-related variables and disability over the first five years of inflammatory polyarthritis: a longitudinal analysis using generalized estimating equations.
J Clin Epidemiol, 53 (2000), pp. 988-996
[11.]
H. Visser, S. le Cessie, K. Vos, F.C. Breedveld, J.M. Hazes.
How to diagnose rheumatoid arthritis early: a prediction model for persistent (erosive) arthritis.
Arthritis Rheum, 46 (2002), pp. 357-365
[12.]
J. Van Aken, L.R. Lard, S. le Cessie, J.M. Hazes, F.C. Breedveld, T.W. Huizinga.
Radiological outcome after four years of early versus delayed treatment strategy in patients with recent onset rheumatoid arthritis.
Ann Rheum Dis, 63 (2004), pp. 274-279
[13.]
I.E. Van der Horst-Bruinsma, I. Speyer, H. Visser, F.C. Breedveld, J.M. Hazes.
Diagnosis and course of early-onset arthritis: results of a special early arthritis clinic compared to routine patient care.
Br J Rheumatol, 37 (1998), pp. 1084-1088
[14.]
D.M. Van der Heijde.
Joint erosions and patients with early rheumatoid arthritis.
Br J Rheumatol, 34 (1995), pp. 74-78
[15.]
M. Bukhari, M. Lunt, B.J. Harrison, D.G. Scott, D.P. Symmons, A.J. Silman.
Rheumatoid factor is the major predictor of increasing severity of radiographic erosions in rheumatoid arthritis: results from the Norfolk Arthritis Register Study, a large inception cohort.
Arthritis Rheum, 46 (2002), pp. 906-912
[16.]
M. Boers, A.C. Verhoeven, H.M. Markusse, M.A. Van de Laar, R. Westhovens, J.C. Van Denderen, et al.
Randomised comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone in early rheumatoid arthritis.
Lancet, 350 (1997), pp. 309-318
[17.]
T. Mottonen, P. Hannonen, M. Korpela, M. Nissila, H. Kautiainen, J. Ilonen, et al.
Delay to institution of therapy and induction of remission using single-drug or combination-disease-modifying antirheumatic drug therapy in early rheumatoid arthritis.
Arthritis Rheum, 46 (2002), pp. 894-898
[18.]
A.A. Van Everdingen, J.W. Jacobs, D.R. Siewertsz Van Reesema, J.W. Bijlsma.
Low-dose prednisone therapy for patients with early active rheumatoid arthritis: clinical efficacy, diseasemodifying properties, and side effects: a randomized, double-blind, placebo-controlled clinical trial.
Ann Intern Med, 136 (2002), pp. 1-12
[19.]
H.A. Capell, R. Madhok, J.A. Hunter, D. Porter, E. Morrison, J. Larkin, et al.
Lack of radiological and clinical benefit over two years of low dose prednisolone for rheumatoid arthritis: results of a randomised controlled trial.
Ann Rheum Dis, 63 (2004), pp. 797-803
[20.]
R.B.M. Landewe.
Treatment in early inflamatory arthritis: the SAVE initiative and the DINORA initiative.
Ann Rheum Dis, 63 (2004), pp. 48
[21.]
M.M. Corkill, B.W. Kirkham, I.C. Chikanza, T. Gibson, G.S. Panayi.
Intramuscular depot methylprednisolone induction of chrysotherapy in rheumatoid arthritis: a 24-week randomized controlled trial.
Br J Rheumatol, 29 (1990), pp. 274-279
[22.]
J.S. Smolen, D. Aletaha, K.P. Machold.
Therapeutic strategies in early rheumatoid arthritis.
Best Pract Res Clin Rheumatol, 19 (2005), pp. 163-177
[23.]
L.R. Lard, H. Visser, I. Speyer, I.E. Vander Horst-Bruinsma, A.H. Zwinderman, F.C. Breedveld, et al.
Early versus delayed treatment in patients with recent-onset rheumatoid arthritis: comparison of two cohorts who received different treatment strategies.
Am J Med, 111 (2001), pp. 446-451
[24.]
R.H. Mullan, B. Bresnihan.
Disease-modifying anti-rheumatic drug therapy and structural damage in early rheumatoid arthritis.
Clin Exp Rheumatol, 21 (2003), pp. S158-S164
[25.]
R. Rau, G. Herborn, H. Menninger, O. Sangha.
Radiographic outcome after three years of patients with early erosive rheumatoid arthritis treated with intramuscular methotrexate or parenteral gold. Extension of a one-year doubleblind study in 174 patients.
Rheumatology (Oxford), 41 (2002), pp. 196-204
[26.]
R. Munro, R. Hampson, A. McEntegart, E.A. Thomson, R. Madhok, H. Capell.
Improved functional outcome in patients with early rheumatoid arthritis treated with intramuscular gold: results of a five year prospective study.
Ann Rheum Dis, 57 (1998), pp. 88-93
[27.]
R. Peltomaa, L. Paimela, T. Helve, M. Leirisalo-Repo.
Comparison of intramuscular gold and sulphasalazine in the treatment of early rheumatoid arthritis. A one year prospective study.
Scand J Rheumatol, 24 (1995), pp. 330-335
[28.]
T.K. Kvien, H.K. Zeidler, P. Hannonen, F.A. Wollheim, O. Forre, I. Hafstrom, et al.
Long term efficacy and safety of cyclosporin versus parenteral gold in early rheumatoid arthritis: a three year study of radiographic progression, renal function, and arterial hypertension.
Ann Rheum Dis, 61 (2002), pp. 511-516
[29.]
D.M. Van der Heijde, P.L. Van Riel, I.H. Nuver-Zwart, L.B. Van de Putte.
Sulphasalazine versus hydroxychloroquine in rheumatoid arthritis: 3-year follow-up.
Lancet, 335 (1990), pp. 539
[30.]
E.H. Choy, D.L. Scott, G.H. Kingsley, P. Williams, J. Wojtulewski, G. Papasavvas, et al.
Treating rheumatoid arthritis early with disease modifying drugs reduces joint damage: a randomised double blind trial of sulphasalazine vs diclofenac sodium.
Clin Exp Rheumatol, 20 (2002), pp. 351-358
[31.]
P. Hannonen, T. Mottonen, M. Hakola, M. Oka.
Sulfasalazine in early rheumatoid arthritis. A 48-week double-blind, prospective, placebo-controlled study.
Arthritis Rheum, 36 (1993), pp. 1501-1509
[32.]
G. Pasero, F. Priolo, E. Marubini, F. Fantini, G. Ferraccioli, M. Magaro, et al.
Slow progression of joint damage in early rheumatoid arthritis treated with cyclosporin A.
Arthritis Rheum, 39 (1996), pp. 1006-1015
[33.]
A.A. Drosos, P.V. Voulgari, A. Katsaraki, A.K. Zikou.
Influence of cyclosporin A on radiological progression in early rheumatoid arthritis patients: a 42-month prospective study.
Rheumatol Int, 19 (2000), pp. 113-118
[34.]
J.S. Smolen, J.R. Kalden, D.L. Scott, B. Rozman, T.K. Kvien, A. Larsen, et al.
Efficacy and safety of leflunomide compared with placebo and sulphasalazine in active rheumatoid arthritis: a double-blind, randomised, multicentre trial.
Lancet, 353 (1999), pp. 259-266
[35.]
M.M. Alperi, F.J. Ballina, J.L. Riestra, J.A. Fernández, A. Rodríguez, P. Moreno.
Leflunomide treatment in patients with early rheumatoid arthritis and non prior DMARD therapy.
Ann Rheum Dis, 64 (2005), pp. 468
[36.]
J.S. Smolen, T. Sokka, T. Pincus, F.C. Breedveld.
A proposed treatment algorithm for rheumatoid arthritis: aggressive therapy, methotrexate, and quantitative measures.
Clin Exp Rheumatol, 21 (2003), pp. S209-S210
[37.]
M. Dougados, B. Combe, A. Cantagrel, P. Goupille, P. Olive, M. Schattenkirchner, et al.
Combination therapy in early rheumatoid arthritis: a randomised, controlled, double blind 52 week clinical trial of sulphasalazine and methotrexate compared with the single components.
Ann Rheum Dis, 58 (1999), pp. 220-225
[38.]
J.F. Maillefert, B. Combe, P. Goupille, A. Cantagrel, M. Dougados.
Long term structural effects of combination therapy in patients with early rheumatoid arthritis: five year follow up of a prospective double blind controlled study.
Ann Rheum Dis, 62 (2003), pp. 764-766
[39.]
C.J. Haagsma, P.L. Van Riel, A.J. De Jong, L.B. Van de Putte.
Combination of sulphasalazine and methotrexate versus the single components in early rheumatoid arthritis: a randomized, controlled, double-blind, 52 week clinical trial.
Br J Rheumatol, 36 (1997), pp. 1082-1088
[40.]
S.M. Proudman, P.G. Conaghan, C. Richardson, B. Griffiths, M.J. Green, D. McGonagle, et al.
Treatment of poor-prognosis early rheumatoid arthritis. A randomized study of treatment with methotrexate, cyclosporin A, and intraarticular corticosteroids compared with sulfasalazine alone.
Arthritis Rheum, 43 (2000), pp. 1809-1819
[41.]
M. Dougados, J.S. Smolen.
Pharmacological management of early rheumatoid arthritis - does combination therapy improve outcomes?.
J Rheumatol, 66 (2002), pp. 20-26
[42.]
M. Calguneri, S. Pay, Z. Caliskaner, S. Apras, S. Kiraz, I. Ertenli, et al.
Combination therapy versus monotherapy for the treatment of patients with rheumatoid arthritis.
Clin Exp Rheumatol, 17 (1999), pp. 699-704
[43.]
R.B. Landewe, M. Boers, A.C. Verhoeven, R. Westhovens, M.A. Van de Laar, H.M. Markusse, et al.
COBRA combination therapy in patients with early rheumatoid arthritis: long-term structural benefits of a brief intervention.
Arthritis Rheum, 46 (2002), pp. 347-356
[44.]
J.K. De Vries-Bouwstra, Y.P.M. Goekoop-Ruiterman, D. Van Zeben, F.C. Breedveld, B.A.C. Dijkmans, J.M.W. Hazes, et al.
A comparison of clinical and radiological outcomes of four treatment strategies for early rheumatoid arthritis: results of the Best trial.
Ann Rheum Dis, 63 (2004), pp. 58
[45.]
C. Grigor, H. Capell, A. Stirling, A.D. McMahon, P. Lock, R. Vallance, et al.
Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial.
Lancet, 364 (2004), pp. 263-269
[46.]
J.M. Bathon, R.W. Martin, R.M. Fleischmann, J.R. Tesser, M.H. Schiff, E.C. Keystone, et al.
A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis.
N Engl J Med, 343 (2000), pp. 1586-1593
[47.]
M.C. Genovese, J.M. Bathon, R.W. Martin, R.M. Fleischmann, J.R. Tesser, M.H. Schiff, et al.
Etanercept versus methotrexate in patients with early rheumatoid arthritis: two-year radiographic and clinical outcomes.
Arthritis Rheum, 46 (2002), pp. 1443-1450
[48.]
L. Klareskog, D. Van der Heijde, J.P. De Jager, A. Gough, J. Kalden, M. Malaise, et al.
Therapeutic effect of the combination of etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: double-blind randomised controlled trial.
Lancet, 363 (2004), pp. 675-681
[49.]
R.N. Maini, F.C. Breedveld, J.R. Kalden, J.S. Smolen, D. Furst, M.H. Weisman, et al.
Sustained improvement over two years in physical function, structural damage, and signs and symptoms among patients with rheumatoid arthritis treated with infliximab and methotrexate.
Arthritis Rheum, 50 (2004), pp. 1051-1065
[50.]
P.E. Lipsky, D.M. Van der Heijde, E.W. St Clair, D.E. Furst, F.C. Breedveld, J.R. Kalden, et al.
Infliximab and methotrexate in the treatment of rheumatoid arthritis.
N Engl J Med, 343 (2000), pp. 1594-1602
[51.]
F.C. Breedveld, P. Emery, E. Keystone, K. Patel, D.E. Furst, J.R. Kalden, et al.
Infliximab in active early rheumatoid arthritis.
Ann Rheum Dis, 63 (2004), pp. 149-155
[52.]
E.W. St Clair, D.M. Van der Heijde, J.S. Smolen, R.N. Maini, J.M. Bathon, P. Emery, et al.
Combination of infliximab and methotrexate therapy for early rheumatoid arthritis: a randomized, controlled trial.
Arthritis Rheum, 50 (2004), pp. 3432-3443
[53.]
M.A. Quinn, P.G. Conaghan, P.J. O’Connor, Z. Karim, A. Greenstein, A. Brown, et al.
Very early treatment with infliximab in addition to methotrexate in early, poor-prognosis rheumatoid arthritis reduces magnetic resonance imaging evidence of synovitis and damage, with sustained benefit after infliximab withdrawal: results from a twelve-month randomized, double-blind, placebo-controlled trial.
Arthritis Rheum, 52 (2005), pp. 27-35
[54.]
M.E. Weinblatt, E.C. Keystone, D.E. Furst, L.W. Moreland, M.H. Weisman, C.A. Birbara, et al.
Adalimumab, a fully human antitumor necrosis factor alpha monoclonal antibody, for the treatment of rheumatoid arthritis in patients taking concomitant methotrexate: the ARMADA trial.
Arthritis Rheum, 48 (2003), pp. 35-45
[55.]
E.C. Keystone, B. Haraoui, V.P. Bykerk.
Role of adalimumab in the treatment of early rheumatoid arthritis.
Clin Exp Rheumatol, 21 (2003), pp. S198-S199
[56.]
Breedveld FC, Kavanaugh AF, Cohen SB, Pavelka K, Van Vollenhoven R, Perez JL, et al. Early Treatment of Rheumatoid Arthritis (RA) With Adalimumab (Humira#r) Plus Methotrexate vs. Adalimumab Alone or Methotrexate Alone: The PREMIER Study. ACR 2004; San Antonio, US. Abstract L5/ 520.
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