Comment on: British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of rheumatoid arthritis (after the first 2 years): reply

Le résumé fourni par la source

Sir, We thank McLaren and colleagues [1] for raising a difficult issue, which we all wrestled with when developing the BSR/BHPR guidelines [2] and also with the recently published NICE RA Guidelines [3]. The issue over what constitutes optimal treatment is an ongoing area of concern for all. It has been clear from calls to the National Rheumatoid Arthritis Society (NRAS) helpline, annual NRAS surveys to patients and data from the general practice research database (4) that sub-optimal treatment for RA is still a significant problem. After much debate during the development of the NICE guidelines, we concluded that there was sufficient evidence to recommend aggressive multiple therapy for newly diagnosed patients combined with tight control using monthly disease assessment. The emphasis should shift towards addressing the risk of inadequately controlled disease rather than side effects of strictly monitored multiple therapies, especially when faced with a patient who is reluctant to take ‘toxic' drugs.

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