In people with rheumatoid arthritis, the immune system goes haywire, attacking healthy joints and causing inflammation—and, with it, swelling, pain, and heat around the joints. Many doctors who treated rheumatoid prescribe one drug at a time, while most studies look at multiple drugs used together, say the authors of a new Scottish study who compared routine and intensive treatment of rheumatoid arthritis.

What the researchers wanted to know: Does keeping close tabs on rheumatoid arthritis help control the disease?

What they did: Adult patients at two teaching hospitals in Glasgow who agreed to participate were randomly assigned to get routine management or intensive management of their rheumatoid arthritis. Patients had had rheumatoid arthritis for less than five years; 110 started the 18-month-long study. Patients in the intensive group had an appointment every month with one rheumatologist who rated the disease and decided what to do about it. Patients in the routine care group had appointments only once every three months and were seen by one of a few rheumatologists and some rheumatologists in training. The rheumatologists decided what drugs to give the patients in the usual way, without formally rating the disease. To get data for the study, someone talked to patients in both groups once every three months.

What they found: This may not be a big shock: Patients who were seen by the same doctor every month did better. Their disease activity fell much more than that of patients getting routine care. Somewhat more surprisingly, their care also cost less, mostly because more money was spent hospitalizing the routine care patients. One difference in care was that two thirds of the patients in the intensively managed group were taking multiple antirheumatic drugs, while all but a handful of patients in the routine-care group were taking just one drug.

What the study means to you: More intensive care seems to help rheumatoid arthritis patients, but good luck getting your very busy doctor on board.

Caveats: The study was carried out in the United Kingdom's National Health System, so routine care could differ in other places.

Find out more: Rheumatoid arthritis, from the Mayo Clinic: www.mayoclinic.com and the Arthritis Foundation: www.arthritis.org

Read the article: Grigor, C., Capell, H., Stirling, A., McMahon, A., Lock, P., Vallance, R., Kincaid, W., and D. Porter. "Effect of a Treatment Strategy of Tight Control for Rheumatoid Arthritis (the TICORA Study): a Single-Blind Randomised Controlled Trial." The Lancet. July 17, 2004, Vol. 364, pp. 263-269.