Rheumatoid Arthritis Best Practice Guidelines Research Proposal

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Rheumatoid Arthritis Best Practice Guidelines

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Best Practice Guidelines for Rheumatoid Arthritis: Target-to-Treat

Best Practice Guidelines for Rheumatoid Arthritis: Target-to-Treat

Palmer and Miedany (2012) believed there was a need to review recent evidence supporting the early diagnosis and aggressive treatment of rheumatoid arthritis (RA). From their perspective, and that of others cited in their publication, the treatment strategy they formulate provides the best patient outcomes in terms of disease severity, complications, mortality, and socioeconomic costs. The title of the publication includes the term "treat-to-target," which means treatment should have a goal of remission or low disease activity. According to the authors this is accomplished primarily through the use of pharmacological agents that modify RA disease progression. Given the proven effectiveness of these drugs, the authors and others consider this approach current best practice. This review article is therefore intended to inform clinicians of the latest advances in RA disease management and provide a guideline for optimizing treatment for individual patients, thereby limiting the toll that RA takes on patients, their loved ones, and society.

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To frame their argument Palmer and Miedany (2012) provide a detailed review what is known about two classes of drugs that modify RA disease process. The first are referred to as disease-modifying antirheumatic drugs (DMARDs), which function by suppressing an immune system actively reacting to autoantigens. A number of DMARDs are discussed, but the centerpiece remains methotrexate as the drug of first choice. A limited number of scientific studies are cited to support their argument. An algorithm is presented in Figure 4 that outlines the treatment decisions clinicians will face during RA management. The primary variables in this decision tree are disease severity, remission, residual disease, refractory disease, and duration of drug use. Some of the decision points concerning DMARDs include whether to continue monotherapy or combine methotrexate with other DMARDs.

Research Proposal on Rheumatoid Arthritis Best Practice Guidelines Assignment

The second class of drugs discussed in detail is biologicals, with tumor necrosis factor (TNF) inhibitors representing the most commonly prescribed (Palmer & Miedany, 2012). Since the risk of side effects is considerably higher for biologicals compared to DMARDs, these drugs are reserved for patients who fail to respond to DMARD therapy. This recommendation is reflected in the clinical decision tree in Figure 4. Tables are also provided that concisely summarize the advantages and risks associated with both DMARDs and biologicals.

RA drugs in development are also discussed in some detail towards the end of the publication (Palmer & Miedany, 2012). The targets of these drugs are immune cells and the secreted cytokines that help manifest and control an immune response. Given the success of TNF inhibitors, the expectation is that this class of drugs will gradually become more effective and elicit fewer adverse reactions as researchers tinker with the chemistry of these agents.

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