July, 2004 - Though it has been well established that RA should be treated early, a definitive window for optimal treatment time had yet to be established. In a prospective case-control parallel-group study, 40 early RA patients were classified into two groups: very early RA (VERA), who initially received DMARD therapy at a median of 3 months after the onset of symptoms; and late early RA (LERA), who initially received DMARD treatment at a median of 12 months after symptom onset. After 3 months of therapy, the VERA group had greater improvement in DAS28 than the LERA group; after 36 months, the VERA group had a disease activity score (DAS28) of 2.8 ±1.5, compared to the VERA group DAS28 score of 1.7±1.2. Larsen method scores also showed that the VERA group had a greater retardation of disease progression at 36 months, compared to the LERA group. Researchers found that "most importantly, the major differences between the two groups occurred within the first year and especially during the first 3 months of treatment... this suggests that in very early arthritis, but not in arthritis lasting for just a short time longer, disease progression can be halted rapidly." They also suggest that the increased effectiveness of very early DMARD therapy allows newer and costlier therapies to be reserved for patients who do not respond to DMARDs.

Nell VPK, Machold KP, Eberl G, Stamm TA, Uffmann M, Smolen JS. Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology 2004;43:906-914.

Link to abstract