A study published in the December issue of the Annals of Rheumatic Disease describe what many people with who have had RA may already know; that new drugs and more aggressive treatment with these drugs has improved the health status of people with RA over the last 15 years. The Norwegian study surveyed almost 1,000 people with RA four times over a period of 10 years (1994-2004) and found that the health status of these patients consistently improved over that time, in terms of physical health, global health and pain. The believe that the improvement is the result of more aggressive early treatment and better access overall to drugs for patients, as well as closer management of the treatment regime by physicians.
Another recent study from Spain also found that the best results come from more effective management of drug treatment, rather than access to new therapies. The team of researchers followed almost 800 patients in Spain from 2000-2004. The study, published online in Arthritis Research and Therapy concluded that while the clinical development of drugs has made great advances, it is the physician's management of the available drugs, old and new, that makes the most difference. The researchers in Spain found that clinical trial results tend to show levels of remission and halts in disease progression that are not enjoyed by patients in real life. The authors stated that this difference could be due to patients included in clinical trials being younger on average, having fewer comorbidities and being selected for trial because they have a higher level of disease activity than real-life patients. The authors found that real-life RA patients (with both severe and mild disease) improved in terms of disease activity, disability and radiological progression independently of the availability of new therapies. The study seemed to conclude that better management by doctors in the future, meaning better selection of patients for early biologic treatment, will improve patients' therapeutic response to treatment, their functional outcomes, and will improve cost-effectiveness of these drugs avoiding unnecessary prescriptions.
While these studies are clearly focused on better drug management from the physician's perspective, I think the theme of better management is a broader goal for both patients and health care providers. For physicians and ancillary health care providers, it means not only keeping up with the latest innovations, but really taking the time to talk to their patients, listen to questions and concerns and follow the effectiveness of the treatments they prescribe. I also believe that better management is more than drugs, it is also management of lifestyle- patient education on diet, exercise, life stress and managing job duties.