TY - JOUR T1 - Anti-Tumor Necrosis Factor Agents Are Mostly Used in Patients with Established Rheumatoid Arthritis Compared to Early Disease — A Reflection of Adequate Clinical Practice JF - The Journal of Rheumatology JO - J Rheumatol SP - 1561 LP - 1562 DO - 10.3899/jrheum.090594 VL - 36 IS - 8 AU - BOULOS HARAOUI Y1 - 2009/08/01 UR - http://www.jrheum.org/content/36/8/1561.abstract N2 - Almost 10 years after the introduction of the anti-tumor necrosis factor (TNF) agents for the treatment of rheumatoid arthritis (RA), rheumatologists are still struggling with their appropriate use and especially with the time to start them in the disease course. It is now well accepted that earlier disease control, i.e., suppression of inflammation, translates into better outcomes in terms of halting radiographic damage progression and preventing functional disability. Several clinical trials have shown the superiority of earlier use of combination methotrexate (MTX) and an anti-TNF agent1–3 compared to either agent used alone. However, given the cost of these new agents, economic considerations and the absence of predictive markers of response have prevented their use as first-line agents. Several national and international guidelines and consensus statements on the use of anti-TNF agents have been published4, the latest being the American College of Rheumatology recommendation document5.Except for the European registries, which deal mostly with safety issues, there is little information on the practical use and effectiveness of anti-TNF agents, especially in early disease versus established RA. The article by Lee, … Address correspondence to Dr. B. Haraoui, CHUM, Campus Notre-Dame, 1560 Sherbrooke est, Montreal, Quebec H2L 1S6. E-mail: bharaoui{at}videotron.ca ER -