When should a patient with RA be started on a DMARD?
Once the diagnosis of RA is established, all patients (with rare exception) should begin DMARD therapy. Bone erosions and joint space narrowing develop within the first 2 years of disease in most patients and are progressive from that point onward. Therefore, early, aggressive treatment with DMARDs is warranted. Additionally, patients with RA who have evidence of active disease (synovitis, morning stiffness, etc.), bony erosions or deformities, or extraarticular disease manifestations and are not already on DMARDs should begin treatment immediately.