Rheumatoid arthritis (RA) is an inflammatory disease of the connective tissues of the body, particularly the synovial joints. Persistent inflammation may lead to damage of the joint capsule and the articular cartilage. Several clinical trials and studies in daily clinical practice have shown that early, aggressive suppression of inflammation leading to sustained remission or at least a state of low disease activity can prevent or minimize joint damage and associated disability. Current treatment guidelines advocate treat-to-target (T2T) as the optimal treatment approach. In this thesis, initial DMARD combination therapy is effective, safe and easy to implement in daily clinical practice by patients as well as for rheumatologists and nurses. Moreover, implementing DMARD combination therapy as a first choice approach for patients with newly diagnosed RA patients is sensible, not only from a medical perspective, but also from an economic perspective. Initial combination therapy is a highly cost-effective treatment approach. Patients will have many benefits from implementation of initial DMARD combination therapy, because this approach gives patients a better prognosis (fast remission, higher remission rates, and less radiographic damage) than patients who were treated according to a step-up DMARD monotherapy approach. Therefore, we recommend this treatment to all rheumatologists and to prescribe initial DMARD combination therapy to newly diagnosed RA patients. In case of treatment failure, patients can rapidly switch after 24 weeks to a biological in combination with a csDMARD. The combination treatment approach was confirmed a fast, effective as well as cost-effective treatment for patients with early RA to increase the chances of retrieving their quality of life and retarding or preventing long-term progression of damage to their joints. Previously, the implementation of T2T has shown successful results. This thesis showed that the implementation of T2T with initial DMARD combination therapy is even more successful and should now be the standard of care in all hospitals for all RA patients.
|Award date||21 Dec 2018|
|Place of Publication||Enschede|
|Publication status||Published - 21 Dec 2018|