الفهرس 
Rheumatoid ArthritisOnly 14 pages are availabe for public view
 |  | from | 181 |  |  |
| | | from | 181 | | |
Abstract
Early diagnosis and management of RA presents an important opportunity to alter the course of this progressive disease.Existence of a window of therapeutic opportunity for RA patient, the period when appropriate therapy for this disease would determine clinical improvement, led to the concept that early diagnosis and treatment can change the disease’s course. Currently, the goal is to evaluate patients with joint symptoms at the earliest opportunity (Mota et al., 2010).
Diagnostic methods have improved with availability of highly specific tests such as ACCP(specificity 96%), and introduction of advanced imaging modalities such as US and MRI to facilitate earlier diagnosis. The current aim of management is to achieve remission and prevent joint damage. In order to achieve this goal, inflammation is suppressed as much as possible during the early phase of the disease before onset of joint damage.
Aggressive treatments with combinations of DMARDs are commenced earlier in the course of disease, and tight control maintained with regular objective monitoring of disease activity. Early use of anti-TNFα therapy in combination with MTX helps to achieve better clinical and radiographic outcomes, which can be maintained for up to 5 years after withdrawal of anti-TNFα therapy. Apart from anti-TNFα, several other biological treatments are now available, including those that target CD20 on Bcells (rituximab), cytokines such as IL1 (anakinra) and IL6 (tocilizumab), and molecules that cause interaction between APS and T cells (abatacept) (Suresh,2010).
The new ACR / EULAR classification criteria are an important support for making a clinical diagnosis in any case. MTX was, and still is, the cornerstone of DMARD regimens. Recent trials that used biologic agents offered valuable information about MTX and its efficacy in RA treatment (Tuhina Neogi et al., 2010).
In conclusion the management of RA has changed substantially over recent years. The emphases are now on early recognition of persistent synovitis in primary care, rapid referral to specialist services and prompt use of DMARDs. For patients with newly diagnosed active RA, a combination of DMARDs should be offered as first-line treatment as soon as possible. Corticosteroids should be administered in early disease, but are not a good long-term strategy for most patients. A multidisciplinary team is important,and patient education is essential. Tumour necrosis factor-a inhibitors
and other cytokine modulators have had a big impact on the
management of RA not responding to conventional DMARDs It is sometimes possible to reduce therapy in patients who are doing well, but whether DMARDs can be safely stopped in all patients in remission is highly contentious.The eligibility for biological drugs so that pharmacological strategies will make remission the rule and not the exception (Tina Ding ., 2010) .