When it comes to treatment of arthritis, are we being too aggressive with treatment or are we not doing enough? It seems like when it comes to arthritis treatment we seem to hear things that sound like we are sometimes doing too much to patients, and other times it sounds like we’re not doing enough. The answer is of course something in between. We aren’t doing enough for lots of our patients, and some folks are getting riskier treatments when less risky would be more appropriate.


For rheumatoid and psoriatic arthritis the concept of treat to target is our current mantra. The target being remission, so continuing to escalate treatment until that is achieved is the current paradigm. Interestingly, studies show that even amongst rheumatologists who believe in the idea of treat to remission, in reality they aren’t being aggressive enough. There is room for improvement.


For osteoarthritis and tendinitis, physicians frequently miss the target as well. Treating only pain symptoms without correcting underlying processes driving a problem is under treating the source of the problem and over treating with pain medications that may have worse potential side effects than most people realize. Jumping to major elective surgery before maxing out on significantly less risky available cell based treatments is another example.


So how can you avoid the over and under treatment syndrome that most of medicine seems to suffer from? First and foremost be educated about the nature of your problem. How will your condition progress without intervention? Is it possible to intervene? What are the options for intervention? What are the risks of intervening? This takes work. It takes open and clear discussions with your physician. It takes doing research on your own. And it may take looking beyond your current care providers.


Treating more aggressively in a safe manner requires a balanced approach of knowing when to be aggressive and when to cut back.  It’s a subtle detail oriented process that doesn’t fit well with algorithmic care. This process doesn’t fit with the current emphasis on large corporate centralized medicine where one size fits all solutions are used.  Top down systems that emphasize computerized box checking don’t fit well with personalized solutions.  As a patient you need to continue to learn more about newer treatments and push your physicians to consider all treatment options.  The nature of healthcare in the US is that this doesn’t always happen, and some of the upcoming administrative changes with healthcare reform will make personalized solutions even harder to obtain.  Finding the right team to support you will be even more important in the future. Getting the balance right is still possible, but will require a focus on continuous improvement and rethinking older paradigms. In the end that will be the only way to make sure you are being treated with the best possible options available.


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