The Rheumatologist reports on changes in the field of rheumatology based on a session at the 2018 ACR/ARHP Annual Meeting.

Vivian Bykerk, BSc, MD, FRCPC, rheumatologist and director of the Inflammatory Arthritis Center at HSS, explains that randomized, controlled trials and observational studies have found that de-escalating treatment (i.e. reducing a dose) can lead to drug-free remission in some patients but can sometimes see a worse outcome when it isn't successful.

De-escalating treatment does have its own practical challenges. "Worsening in terms of symptoms and impacts may occur between scheduled clinical encounters," she says. "Worsening may not occur for many months or even one to two years," when a patient might not have a follow-up visit.

Dr. Bykerk says that personalized strategies of integrated induction followed by de-escalation will likely be the key to cost-effective improved care.

Read the full article at The-Rheumatologist.org.