DAS-driven therapy versus routine care in patients with recent-onset active rheumatoid arthritis
- Y P M Goekoop-Ruiterman1,
- J K de Vries-Bouwstra2,
- P J S M Kerstens3,
- M M J Nielen3,
- K Vos3,
- D van Schaardenburg2,3,
- I Speyer4,
- P E H Seys5,
- F C Breedveld1,
- C F Allaart1,
- B A C Dijkmans2,3
- 1Leiden University Medical Centre, Leiden, The Netherlands
- 2VU Medical Centre, Amsterdam, The Netherlands
- 3Jan van Breemen Institute, Amsterdam, The Netherlands
- 4Hospital Bronovo, The Hague, The Netherlands
- 5Hospital Lievensberg, Bergen op Zoom, The Netherlands
- Correspondence to Mrs Y P M Goekoop-Ruiterman, Leiden University Medical Centre, Department of Rheumatology C-1-R, PO Box 9600, 2300 RC Leiden, The Netherlands; y.p.m.goekoop{at}lumc.nl
- Accepted 12 January 2009
- Published Online First 20 January 2009
Abstract
Objectives: To compare the efficacy of Disease Activity Score (DAS)-driven therapy and routine care in patients with recent-onset rheumatoid arthritis.
Methods: Patients with recent-onset rheumatoid arthritis receiving traditional antirheumatic therapy from either the BeSt study, a randomised controlled trial comparing different treatment strategies (group A), or two Early Arthritis Clinics (group B) were included. In group A, systematic DAS-driven treatment adjustments aimed to achieve low disease activity (DAS ≤2.4). In group B, treatment was left to the discretion of the treating doctor. Functional ability (Health Assessment Questionnaire (HAQ)), Disease Activity Score in 28 joints (DAS28) and Sharp/van der Heijde radiographic score (SHS) were evaluated.
Results: At baseline, patients in group A (n = 234) and group B (n = 201) had comparable demographic characteristics and a mean HAQ of 1.4. Group A had a longer median disease duration than group B (0.5 vs 0.4 years, p = 0.016), a higher mean DAS28 (6.1 vs 5.7, p<0.001), more rheumatoid factor-positive patients (66% vs 42%, p<0.001) and more patients with erosions (71% vs 53%, p<0.001). After 1 year, the HAQ improvement was 0.7 vs 0.5 (p = 0.029), and the percentage in remission (DAS28 <2.6) 31% vs 18% (p<0.005) in groups A and B, respectively. In group A, the median SHS progression was 2.0 (expected progression 7.0), in group B, the SHS progression was 1.0 (expected progression 4.4).
Conclusions: In patients with recent-onset rheumatoid arthritis receiving traditional treatment, systematic DAS-driven therapy results in significantly better clinical improvement and possibly improves the suppression of joint damage progression.
Footnotes
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Funding This study was funded by a grant from the Dutch College of Health Insurances (College Voor Zorgverzekeringen) with additional funding provided by Schering-Plough, BV and Centocor.
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Competing interests CFA and FCB have received lecture fees from Schering-Plough; BACD has received funds for research and lecture fees from Schering-Plough.
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Ethics approval Ethics committee approval from all participating centres.
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Patient consent Patient consent received.
