Though there's no known cure for the stiffness, swelling, joint pain, and fatigue of rheumatoid arthritis, millions of people who live with the disease now receive better diagnoses and have access to new medications. This month, researchers from the Netherlands found evidence that suggests these advancements might help: Over the past 20 years rheumatoid arthritis symptoms have become milder.

Scientists from Radboud University Nijmegen Medical Centre studied 525 patients who started treatment for rheumatoid arthritis in the past 20 years. The researchers found that patients who received their diagnosis between 2000 and 2005 had milder symptoms when treatment started, and fared better in subsequent years, than those who started treatment between 1985 and 1990, 1990 and 1995, and 1995 and 2000. When the researchers compared patients with the same level of arthritis at the start of treatment, those patients in the most recent groups showed less severe symptoms over time.

To measure the severity of rheumatoid arthritis in each patient, every three months, researchers measured the level of tenderness and swelling in 28 joints including the shoulders, elbows, wrists, and knees. In addition, every six months, patients filled out questionnaires that asked about the individual's levels of pain and functioning. Though the examination of 28 joints in each patient showed that rheumatoid arthritis got milder in the most recent groups of patients, the questionnaires did not show any improvement.

This discrepancy, according to the study's lead author, Paco Welsing, might indicate that patients today expect more from their healthcare than they did 20 years ago. "They are not satisfied with their disease state, which is actually better than 20 years ago," Welsing said in an E-mail interview.

During the study, patients underwent a variety of treatments including taking prednisone, an anti-inflammatory steroid drug, and so-called disease-modifying antirheumatic drugs (DMARD) like sulfasalazine. Welsing explained that the study could not make any conclusions about which treatments worked best because of the experimental design. The study also didn't rule out environmental factors that might make patients less prone to severe symptoms in more recent years. Nevertheless, the study most likely indicates that rheumatoid arthritis patients receive better treatment, in general, than they did two decades ago, including earlier referral to arthritis specialists, earlier treatment, and more-aggressive treatment strategies.

Welsing said that future studies might compare these specific treatment strategies to find out which work best. Future studies might also focus on the populations that these rheumatoid arthritis patients come from to find out if patients do indeed see arthritis specialists earlier than in years past.