"Rheumatoid arthritis not only induces permanent joint deformities and damages but also has a detrimental effect on quality of life due to many general symptoms. As effective disease management becomes possible following the recent introduction of various treatment options, early diagnosis and patient-customized treatment approach are crucial."

New treatment options for rheumatoid arthritis have improved unmet needs in clinical practices and increased disease awareness.

However, despite the rising diagnosis rate, some patients receive a diagnosis after the disease progresses to severe symptoms. Yunjung Choi, Professor in the Division of Rheumatology at Jeonbuk National University Hospital, has emphasized the importance of early diagnosis of rheumatoid arthritis, explaining the disease characteristics and the latest treatment advances.

Rheumatoid arthritis is the most common autoimmune disease where abnormally activated immune cells invade joints, causing inflammation and pain.

"Rheumatoid arthritis is mainly caused by inflammation in the thin tissue lining of joints. The disease symmetrically affects small joints in the hand and foot, damaging bones and cartilage surrounding the tissue lining of joints. It leads to joint deformities and loss of joint function." Choi added, "JAK inhibitors that can be orally administered and have almost similar effects now enable patients to manage arthritis effectively."

The treatment options for rheumatoid arthritis broadened following the introduction of conventional disease-modifying antirheumatic drugs (cDMARDs), biological agents, and Janus Kinase (JAK) inhibitors.

"Patients who have not reached treatment goals after being treated with cDMARDs in primary healthcare centers are often transferred to secondary healthcare centers or university hospitals," Choi said. "Many of them are moderate to higher patients who have poor prognosis factors, and they consider either biological agents or JAK inhibitors."

"Customizing treatment to individual patient is necessary. For instance, adapting to patient conditions to prevent and manage side effects, ensure administration convenience, and evaluate drug compliance," Choi emphasized.

The current clinical practices use cDMARDS, biological agents, and JAK inhibitors based on the 2021 American College of Rheumatology Guideline and the 2022 European Alliance of Associations for Rheumatology classification recommendations.

With JAK inhibitors recently added to the reimbursement list, patients now have treatment options that offer the convenience of oral administration, less burden than injectables, and high efficacy comparable to biological agents.

Choi said such a change has contributed to increased patient drug compliance and provided effective treatment options to medical practitioners.

Regarding the benefits of JAK inhibitors, Choi said, "At first, there were concerns about JAK inhibitors for cardiovascular system-associated side effects, but follow-up research outcomes have shown that such risks are gradually alleviating." Choi added, "We hope more data in South Korea becomes available and anticipate safer drug use considering ages and existing health conditions."

"There is a need for improvements in the rheumatoid arthritis system with blind spot"

Furthermore, there is a need to improve a system regarding drug switching for rheumatoid arthritis treatment.

For instance, switching to another JAK inhibitor is difficult when a patient does not respond to a JAK inhibitor. Some people have demanded systematic improvements.

Positive changes are expected regarding this issue. The Health Insurance Review and Assessment Service (HIRA) has suggested a criterion for drug switching needs, establishing 'An assessment criterion for evaluating drug switching effects for rheumatoid arthritis.'

In addition, Choi emphasizes the need to expand support for patients with serotype-negative rheumatoid arthritis.

"About 80% of patients with rheumatoid arthritis are diagnosed with antibody positivity. But, the rest of the 20% are found to be antibody-negative, posing difficulty in receiving benefits," Choi said. "These patients require treatments their whole lives, experiencing joint damage and functional deficits. Because they are excluded from benefits, improvements to the policy may be necessary."

Additionally, Choi pointed out that patients who use biological agents are recommended for immunization to prevent shingles, but many experience considerable cost burdens.

"Shingles immunization is crucial for patient safety, but its high cost poses an additional burden to patients. Systematic support is required to lower the economical hurdle," Choi said.

Lastly, Choi reiterates the importance of early diagnosis to seize the 'golden time' for treating rheumatoid arthritis.

"Many patients endure symptoms thinking that they feel pain from using their hands frequently, but end up visiting hospitals once the disease has worsened. When an individual feels one's hand stiff and hard to grasp, and feels extensive pain in the body, one should not disregard it simply as fatigue," Choi advises.

When morning stiffness lasts over 30 minutes on more than two occasions within two weeks, it may indicate early rheumatoid arthritis. Individuals must consult rheumatology specialists for an accurate diagnosis and a suitable treatment plan.

"An early intervention makes a significant difference in preventing joint damages and preserving quality of life," Choi said. "Patients need to recognize disease early and proactively seek treatments."