The development of biological therapies transformed the treatment of rheumatoid arthritis, but there’s still much debate about how and when to use these drugs. Our researchers highlighted the importance of starting early, intensive treatment within 12 weeks of symptom onset.
A new approach to treatment
Traditionally the approach with biological therapies had been conservative. Treatment was escalated as symptoms progressed.
But research at the University of Leeds, led by Professor Paul Emery, transformed the standard management of rheumatoid arthritis. The focus changed to early diagnosis and aggressive treatment with the aim of disease remission, as opposed to symptom management.
This is the result of findings that treating patients within 12 weeks of symptom onset is crucial to prevent pain and reduce the risk of long-term joint damage and disability.
Biological therapy was shown to be safe and effective for patients with very early disease, with significant benefits observed after eight years without the need for continued treatment. A similar aggressive approach is also effective for psoriatic arthritis.
Identify reasons for delays
Subsequent research led by Professor Karim Raza at the University of Birmingham reinforced the importance of starting treatment for rheumatoid arthritis within 12 weeks of symptom onset.
Studies highlighted the delay in patients receiving specialist care and identified underlying reasons for the delay, including:
- patient delay in seeking help from their GP – particularly for patients of South Asian origin
- GP delay in referring the patient.
This line of research was supported in part by grants from us, with funding also coming from the National Institute of Health Research (NIHR), European Commission, Medical Research Council (MRC) and others.
Together, these key findings have informed guidelines for treating rheumatoid arthritis developed by national bodies including the National Audit Office, the National Institute for Health and Care Excellence (NICE), and the Arthritis and Musculoskeletal Alliance. All of these bodies recommend early referral and early and aggressive treatment.
Outside of the UK, the evidence has also informed the joint European and American Guidelines.
Introduction of a best practice tariff
In 2013, our policy team and the British Society for Rheumatology, worked with the Department of Health to develop a best practice tariff for people with rheumatoid arthritis.
As a result, people with inflammatory arthritis should expect to:
- be seen by a rheumatologist within three weeks of being referred by their GP
- receive diagnosis and start treatment within six weeks of GP referral.
It’s estimated that early treatment of rheumatoid arthritis is associated with annual productivity gains to the UK economy of £6.2million. This more than outweighs the estimated additional annual cost of £2.2million to the healthcare system.