Management of Early Rheumatoid Arthritis: Solving the unresolved the tREACH trial

Abstract

Rheumatoid arthritis (RA) is a systemic auto-immune disease, which is characterized by chronic inflammation of multiple joints. About 1% of the people in western countries have RA, and each year in 5 – 50 per 100.000 persons the diagnose of RA is made. The prevalence of RA varies geographically.1 In the Netherlands the prevalence of RA in 2007, based of primary care registries, was 0.7% (95% confidence interval (CI): 0.48% - 1.03%) for men and 1.1% (95% CI: 0.76% - 1.60%) for women. The mean annual incidence in the Netherlands in 2007 was respectively 75 and 120 per 100.000 for men and women. Disease onset is most often between 40 and 60 years of age. The mortality rate for men and women with RA in 2010 was respectively 0.3 and 0.9 per 100.000.2 Clinical and radiographic outcomes have improved enormously in the last two decades, due to major paradigm changes in the management of RA.3-4 Evolvement of clinical trial methodology, emergement of new therapeutic options – in particular biologicals – and reevaluating treatment strategies caused these major paradigm changes.