Early aggressive treatment means starting stronger medications early in the course of the disease. If you have rheumatoid arthritis or one of the other types of arthritis which can cause deformity and disability, early treatment may prevent joint damage and slow disease progression. With the availability of better treatments, the prognosis is not as dismal as it was decades ago.

There are indicators that predict a more severe course of disease with rheumatoid arthritis:

• Early (i.e., younger age of) onset of severe synovitis

• Early evidence of functional limitation

• Positive test for rheumatoid factor

• Evidence of joint erosions on medical images

• Persistently elevated sedrate and CRP

• Positive test for anti-CCP

• Systemic involvement

• Family history of rheumatoid arthritis

Approximately 17.4 million adults in the United States with doctor-diagnosed arthritis report arthritis-attributable activity limitations, according to the Centers for Disease Control and Prevention (CDC). Of adults aged 18 to 64 with doctor-diagnosed arthritis, over 30 percent report an arthritis-attributable work limitation.

Patients with a poor prognosis can be helped by early treatment. The disease outcome in terms of severity, disability, and mortality can be impacted. Discuss your best course of treatment with your doctor. Weigh treatment benefits versus risks, and also consider potential complications of uncontrolled comorbid conditions.

Not every arthritis patient needs to be treated aggressively, and despite the recommendation for early aggressive treatment, not all patients are prescribed the more advanced medications (for example, DMARDs, biologic DMARDs) early on. Some patients may actually resist being treated with certain medications.

A study reported in the Annals of the Rheumatic Diseases (2006; 65:1226–1229) used a database from the Consortium of Rheumatology Researchers of North America to compare treatment plans of patients with elderly onset rheumatoid arthritis (disease onset after age sixty years) to younger-onset rheumatoid arthritis (disease onset between forty and sixty years). Study results indicated that elderly onset rheumatoid arthritis patients received combination DMARDs (disease-modifying anti-rheumatic drugs) and biologic treatments less frequently than younger-onset patients, even though both groups had identical disease duration as well as comparable disease severity and activity.

It's wise to have a conversation with your rheumatologist about your current medications and how your doctor intends to step up your treatment plan to gain better control over your symptoms. It's not uncommon for patients to feel uncertain about what's next if the medications they are on fail. If you get a sense of your doctor's thinking regarding your treatment plan, you will be able to wrap your own mind around a more aggressive treatment or using other combinations of medications.