Background Treatment of rheumatoid arthritis (RA) should aim at full remission. However,recent publications described rapid radiographic progression (RRP) existed despite initial biologics and methotrexate combination therapy in early RA. In RRP, treating target to clinical remission might be inadequate.
Objectives To assess whether therapy to achieve both simple disease activity index (SDAI) remissionand ultrasound power Doppler (US-PD) remissionoffers better outcomes than SDAI remission in early RRP RA at 52 weeks.
Methods We designed a single-blind, randomised controlled trial. We screened 41 RRP (CRP 35mg/L, RF+, and ACPA+) early (disease duration <1 year) RA patients for inclusion. 35 were randomly allocated either clinical and ultrasound remission strategy group (CU group) or clinical remission group (C group). Patients received initial combination therapy with tocilizumab (TCZ) and methotrexate (MTX). Targets were SDAI less than 3.3 and PDUS normailsation for the CU group, and SDAI less than 3.3 for C group. For US group, US examinations of both MP and PIP joints, and wrists was performed every 4 weeks. If the value in question did not fall below the previously measured level, medication was intensified, including other disease-modifying antirheumatic drugs and intra articular steroid injection. Primary and other outcomes measure were proportion of patients showing clinical remission (SDAI <3.3), radiographic non-progression (Δmodified total Sharp score ≤0.5), and normal physical function (modified health assessment questionnaire score 0). Analysis was by intention-to-treat.
Results The characteristics of each group at baseline were not significantly different. Clinical remission at 52weeks was achieved by more patients in the CU group (35%) than in the C group (22%) (p<0.05). Radiographic non-progression at 52 weeks was achieved by more patients in the CU group (42%) than in the C group (29%) (p<0.05). Normal physical function was no significant difference between C U group (64%) and C group (58%) (p>0.05).
Conclusions Results of this reveal that clinical and ultrasound strategy can achieve a high clinical and radiological remission rate in early RRP RA.
Effectiveness of initial treatment allocation based on expert opinion for prevention of rapid radiographic progression in daily practice of an early RA cohort. Durnez A, et al. Ann Rheum Dis. 2011 Apr;70(4):634-7. Epub 2010 Dec 21.
A matrix risk model for the prediction of rapid radiographic progression in patients with rheumatoid arthritis receiving different dynamic treatment strategies: post hoc analyses from the BeSt study. Visser K, et al. Ann Rheum Dis. 2010 Jul;69(7):1333-7. Epub 2010 May 24.
A pilot risk model for the prediction of rapid radiographic progression in rheumatoid arthritis. Vastesaeger N, et al. Rheumatology (Oxford). 2009 Sep;48(9):1114-21. Epub 2009 Jul 9. Review.
Disclosure of Interest None Declared