Intensive and early treatment of rheumatoid arthritis reduces fatigue experts advise
Early intensive treatment that combines methotrexate with prednisone can reduce the profound fatigue that impacts many people with rheumatoid arthritis.
The new research from Belgium recommends that even low-risk patients should be considered for early intensive treatment.
“In addition to pain, profound fatigue reduces the quality of life for many people, even more than the swelling of the joints,” explains Prof Iain McInnes from Glasgow. “However, doctors often do not pay sufficient attention to this fact and do not adjust the therapy accordingly.”
A total of 80 people who had rheumatoid arthritis but a low disease activity status were split into two groups. Around half received monotherapy with 15mg methotrexate weekly. The other half were given a combination therapy of 15mg methotrexate weekly plus prednisone starting at 30mg but tapered weekly to 5mg.
Methotrexate suppresses the disease and acute inflammatory reaction, while prednisone has a strong anti-inflammatory effect and should quickly reduce pain and inflammation of the joints.
The findings
People who received intensive treatment with the combination therapy of both drugs for two years were less tired than those in the monotherapy control group, even though the disease activity in both groups were comparable over time. The levels of fatigue seemed to differ more and more over time between groups.
“This underlines the importance of initiating optimal, intensive treatment early on, even in so-called low-risk patients,” says another expert, Prof John Isaacs from Newcastle University. “Unfortunately, this is not yet standard practice. The study clearly shows how fatigue levels in early rheumatoid arthritis can be significantly improved.”
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