Early diagnosis and personalized therapy are key

Hong-Ki Min, Division of Rheumatology, Konkuk University Medical Center

"Early diagnosis and personalized therapy are key to improving the treatment environment for rheumatoid arthritis"

Emergence of diverse treatment options…JAK inhibitors emerge as alternatives to injectables

“The era of personalized treatment has begun…remission can be maintained with early diagnosis”

Hong-Ki Min, Division of Rheumatology, Konkuk University Medical Center

“The treatment options for rheumatoid arthritis (RA) have become far more diverse than in the past.

 

Contrary to the past when management focused primarily on alleviating symptoms, today, with early diagnosis and tailored treatment strategies, it is possible to maintain long-term remission.

 

Patients can now continue their daily lives with fewer limitations, marking a major paradigm shift in their care.” This was the assessment shared by Professor Hong-Ki Min of Konkuk University Medical Center’s Division of Rheumatology in a recent interview with Dailypharm.

 

Rheumatoid arthritis is a common autoimmune disease diagnosed in Korea, where the immune system attacks the joints, causing inflammation that often begins in small joints such as the wrists and fingers, and may progress to larger joints throughout the body, such as the knees and ankles.

 

In its early stages, it is often mistaken for simple joint pain and neglected.

 

However, missing the optimal treatment window can lead to joint deformity and loss of function, significantly restricting daily life.

 

Furthermore, the risk of systemic complications like cardiovascular and pulmonary diseases increases, classifying it as a systemic disease beyond a simple joint disorder.

 

The cornerstone of RA treatment is pharmacotherapy, including disease-modifying antirheumatic drugs (DMARDs) such as methotrexate (MTX).

 

Professor Min explained, “During treatment, it is crucial to monitor not only inflammation suppression but also long-term side effects, infections, and the occurrence of cardiovascular disease.

 

Depending on the patient’s needs, therapy may be switched to biologics or Janus kinase (JAK) inhibitors.” Currently, various treatment options for rheumatoid arthritis have emerged, including not only immunosuppressants but also biologics and JAK inhibitors.

 

Notably, JAK inhibitors like Eisai’s Jyseleca and AbbVie’s Rinvoq have gained attention because they are oral therapies, offering an alternative to injections and significantly improving convenience.

 

Professor Min stated, “JAK inhibitors are evaluated as being equivalent to biologics in terms of efficacy.

 

They represent an important alternative for patients with significant aversion to injections.” “Cross-switching between JAK inhibitors now permitted...

 

expanding treatment options” Previously, patients who switched from biologics to a JAK inhibitor and failed to respond had no choice but to return to biologics, as switching between different JAK inhibitors was not permitted under Korea’s reimbursement regulations.

 

However, following advocacy by physicians and the Korean College of Rheumatology and patient requests, the government approved reimbursement for switching between JAK inhibitors as of December 2023.

 

This has reduced the burden associated with switching between biologics to JAK inhibitors.

 

Professor Min explained that while the expansion of treatment options enables personalized therapy, institutional limitations still exist.

 

Under Korea's health insurance system, switching to a specific drug requires at least six months of use.

 

Even if the effect is insufficient, maintaining the drug for that period is necessary before switching to another option.

 

Professor Min stated, “The rheumatoid arthritis treatment environment has significantly improved compared to the past.

 

New drugs with diverse mechanisms have emerged, and treatment strategies have become more specialized, leading to an increase in patients maintaining remission for extended periods.” He added, “This can be particularly challenging for patients who show resistance to multiple drugs.

 

Some patients cannot revert to their previous medication even if the effect diminishes after switching, leaving physicians in a difficult position.” With treatment options becoming diversified and personalized care made possible, early diagnosis has become more important than ever.

 

Because RA directly attacks the joints, failure to diagnose and treat early can lead to irreversible joint deformities and functional impairment.

 

The Korean College of Rheumatology is running a nationwide campaign under the theme “Early Diagnosis, Specialist Care.” This goes beyond a simple recommendation for medical care and is an academic-level message aimed at preventing long-term complications and preserving patients' quality of life.

 

Professor Min concluded, “RA patients who are not treated in time risk joint damage, deformity, and disability, which significantly reduce quality of life.

 

But today, with more therapeutic options available, patients should not lose hope.

 

With regular specialist care, patients can fully maintain their daily social activities.”