Well, Duh! Why “Obvious” Studies Are Important

Sometimes you read something and you just want to say, “Well, duh!” because you think it’s so completely obvious you wonder why it’s making headlines in the first place.

The significance of low disease activity

The headline of an article I read recently is, “Persistent RA Activity Predicts Major Surgery — Researchers stress importance of securing low disease activity”. To an RA patient, achieving low disease activity (or even remission) seems not only obvious, but the Holy Grail of treatment objectives. It’s almost unbelievable that anyone would think otherwise. And if RA isn’t controlled, a logical outcome can be major joint surgery. So why does it take a major study to state the obvious?

There are some very significant reasons for this.

Ensuring treatment effectiveness and safety

First, from a patient’s perspective, you want to ensure that whatever treatment is given is actually beneficial. Aggressive treatment, which may involve multiple drugs and include expensive biologics, needs to be shown as effective. That is, you want to know the treatment works and you also don’t want the cure to be worse than the disease. You are asking patients to be subjected to what may be serious side effects as well as asking patients and their insurance companies to pay hefty sums of money for these treatments. Without documented, positive results, there is no reason to use these treatments.

Reduction in joint damage with aggressive treatments

The good news is, these aggressive treatments have been shown to reduce joint damage (based on radiographic markers) by as much as 50 percent as reported by Rheumatology. As the article states:

“A number of studies have clearly shown that patients benefit from starting a biologic disease modifying anti-rheumatic drug (DMARD) earlier and at lower levels of disease activity, including moderate disease activity.”

Influence of national care standards

Perhaps even more important, national care standards are based on documented data such as these studies. According to published reports, in several European countries the eligibility for tumor necrosis factor (TNF) treatment leaves out a large portion of early RA patients with low-to-moderate disease activity. (The class of TNF biologic drugs has become a mainstay of modern RA treatment.) However, this latest analysis indicates that the earlier the patient is “treated to target [of remission]” the better the outcome. The better outcome meaning fewer orthopedic surgeries and a higher quality of life.

These kinds of “obvious” studies provide the basis for treatment for all RA patients and help set the course for future treatment objectives around the world.