Rheumatoid arthritis: New treatment guidelines require avoidance of cortisone

Targeted treatment instead of long-term cortisone therapy

Rheumatoid arthritis is often accompanied by the destruction of the affected joints. To prevent this, early and targeted therapy is necessary. The recently published guideline for the treatment of the painful disease gives doctors and those affected an overview of the therapeutic options and treatment trends. Among other things, targeted and early onset care should prevent long-term cortisone intake.

The German Society for Rheumatology (DGRh) was significantly involved in the development of the S2e guideline "Treatment of rheumatoid arthritis with disease-modifying drugs (DMARDs)". The guideline was made available online free of charge in the "Zeitschrift für Rheumatologie".

Over half a million people affected in Germany

According to the DGRh, around 550,000 adults in Germany suffer from rheumatoid arthritis (also called chronic polyarthritis). Chronic joint inflammation is thus the most common inflammatory rheumatic disease. It manifests itself in episodes of relapse and increasingly leads to joint deformations in those affected, which can go as far as complete destruction.

Disease-modifying drugs instead of cortisone

The new guideline focuses on early-onset therapy with so-called "disease-modifying anti-rheumatic drugs" (DMARDs), i.e. disease-modifying drugs, instead of the previously used cortisone. According to the DGRh, these DMARDs can slow the course of the disease and prevent destruction of the joints.

Doctor and patient have to work hand in hand

"However, this only works if the patients are examined regularly and if there is no improvement, the DMARD is changed early," reports Professor Dr. med. Christoph Fiehn from the Medical Center Baden-Baden and first author of the guideline in a press release. The goal of the treatment remains to achieve remission, i.e. the complete disappearance of the disease activity. If this is not possible, the lowest possible disease activity will be sought.

Every second patient is still treated with high-dose cortisone

According to the DGRh, targeted treatment with DMARDs has not yet become widespread. Current data show that a third of patients with rheumatoid arthritis still have moderate to severe disease activity after two years. In this group, every second patient is treated with high-dose cortisone. "These patients have an increased risk of infections, heart diseases and osteoporosis," Fiehn explains the side effects of cortisone.

Lots of alternatives available

According to the experts, there are plenty of alternatives to cortisone treatment. For example, in addition to the conventional synthetic DMARD medications such as methotrexate (MTX) and the biological DMARD, two more targeted synthetic DMARDs with the active ingredients baricitinib and tofacitinib have been added in recent years, which can help against constant joint pain.

Are high drug prices the reason for the hesitation?

"One reason for the rare use is probably the high prices for these drugs," said Professor Fiehn. This problem is addressed in the new guideline. The experts suggest starting treatment with methotrexate (MTX). According to the professor, many patients can successfully treat this medication alone. If MTX was not tolerated, doctors could initially prescribe cheap, synthetic DMARDs such as leflunomide or sulfasalazine.

Early controls on vivacity

An important aspect that the guideline points to is early monitoring of the effectiveness of the initial treatment. The first check-up appointments should take place after six weeks. The first appointments are currently only scheduled after twelve weeks. "After six weeks, the tolerance and adherence, i.e. the patient's adherence to therapy, and the correctness of the dosage should be checked," adds Professor Dr. Hanns-Martin Lorenz, President of the DGRh and Head of the Rheumatology Section at Heidelberg University Hospital.

Many possibilities of action

Regular checks allow doctors to target patients more effectively and react accordingly. "Depending on the response and prognostic factors, the doctor can then prescribe a different DMARD, combine two conventional preparations or start treatment with the biological or specifically synthetic DMARD," the experts suggest.

Complete freedom from complaints can be achieved

The experts emphasize that the procedures of the new guideline can achieve permanent freedom from symptoms in some patients. In such patients, the drug can even be lowered. However, this was only possible if the patients stopped taking cortisone and had been free of symptoms for six months. (vb)

Author and source information

Video: Rheumatoid Arthritis: Evolving Treatment. Brigham and Womens Hospital (July 2021).