Most rheumatologists, if asked, would say that every rheumatoid arthritis patient should be started on a DMARD of some sort - if not at diagnosis, then pretty soon after. So I am genuinely shocked that, in a large United States Medicare 20% sample dataset between 2008-17, less than 30% of new RA patients aged 66 years or older have a DMARD initiated.

Early treatment with DMARDs has revolutionised the outcomes of patients with rheumatic arthritis. However, this concept has not been fully extrapolated to other autoimmune rheumatic diseases such as systemic lupus erythematosus.

Remission had been a dream, an elusive concept. But then, with the introduction of biologics, conventional synthetic and targeted synthetic DMARDS, patients are able to live longer and with a better quality of life. While these therapeutics have been helpful, they are expensive and carry potential side effects. The big question looms: Do we stop or continue treatment?