As patients with autoimmune diseases, including rheumatoid arthritis, have better access to medical care, early diagnosis and treatment have been pointed out as the key.

Early diagnosis and treatments previously available in university hospitals are now possible in local clinics. As a result, patient-personalized therapies, even for patients with mild symptoms, through local clinics have become increasingly important.

"More patients are visiting clinics at early stages compared to the past," Dr. Won-Suk Lee, Chief of Easy Rheumatis Clinic in Jeonju, said. "It is important to provide personalized treatments to improve patient's daily life."

JAK inhibitors for treating rheumatoid arthritis…"We have observed fast treatment effects"

Rheumatoid arthritis is an autoimmune diseases in which abnormally activated immune cells invade joints, causing inflammation and pain. In the past, it was regarded as a disease that required treatment at university hospitals.

However, without properly treating it at an early stage, repeated inflammation over time can cause joint deformity, leading to loss of function. So, the importance of early diagnosis has been emphasized. Specialists in the field of rheumatoid arthritis have opened clinics all over the nation, improving patient access.

"As more specialists in the field of rheumatoid arthritis have opened clinics, patients have better access. More patients now visit clinics at an early stage of the disease compared to the past,"Dr. Lee explained. "There may be differences in disease awareness depending on geographical location, but overall disease awareness has increased."

Along with improved disease awareness, doctors have more treatment options to utilize. Janus Kinase (JAK) inhibitor has brought a significant paradigm shift to the treatment of rheumatoid arthritis.

"Patients initially begin the treatment with DMARDs, a methotrexate (MTX)-based therapy, but when drug response lowers, patients resort to TNF-α inhibitors or JAK inhibitors," Dr. Lee said. "I have been employing a step-wise increasing prescription in patients of young age, according to the guideline."

Dr. Lee quickly switches from prescribing conventional medicine to JAK inhibitors because of the 'effects' and 'convenience.' Compared to conventional medicines, JAK inhibitors have the advantages of requiring less use of steroids and pain killers. They also relieve the patient's administration burden because they are oral drugs.

However, in 2021, an issue of cardiovascular system-related side effects of JAK inhibitor was reported, so there are 'safety'-related concerns.

At the time, the U.S. Food and Drug Administration (FDA) issued warnings related to cardiovascular disease and cancer for JAK inhibitors. The Korean Ministry of Food and Drug Safety (MFDS) also posted safety documents. Ultimately, the FDA decided to include the safety information, including cardiovascular-related instances, thrombosis, and death, on the box warning label.

Dr. Lee commented regarding this issue, "We cannot deny the research, but I have not had cardiovascular-related side effects issues during my years of prescription experience. In my opinion, side effects could be manageable, and the occurrence of shingles is seven times higher in Asia, I explain the vaccination option and prescribe it."

Emphasizes the need to improve medication switching for personalized treatment

The latest issue for rheumatoid arthritis treatment is obtaining insurance reimbursement authorized for switching between JAK inhibitors. Notification was expected within October, but it has been extended.

Dr. Lee commented that we need to consider the criteria for using conventional medicines in addition to the issue of JAK inhibitor switching.

"When medication switching is allowed, patients can choose better treatments, which is the most important point," Dr. Lee said. "The current criteria indicate that when a patient uses conventional medicine and does not benefit, one can use JAK inhibitor after six months. However, we should also consider three months amid the early intervention trend."

Lastly, Dr. Lee emphasized the need for early diagnosis and personalized treatment for the management of rheumatoid arthritis.

"For rheumatoid arthritis, early diagnosis and early treatment are most important, so we focus on treating patients without hindering daily lives, along with pain management," Dr. Lee said. "Rather than repeatedly prescribing the same drug, we need to consider complications and accompanying disease."