Background The Early Rheumatoid Arthritis Clinic (EAC) was established in 2010 to meet NICE recommendations (2009) for treatment of early rheumatoid arthritis .
Objectives Analysis of remission and low disease activity (LDA) rates in patients that have been followed up for 1 year.
Methods Patients seen in EAC are adults (>18 years of age) with a new diagnosis of RA (≤2 years) and active disease (DAS28>3.2) at the first visit. Target of treatment was remission (DAS28 <2.6) or LDA (DAS28 <3.2). We used an agreed protocol for treatment escalation. Activity measure was DAS28-CRP. Patients were seen every 4-6 weeks. Treatment was escalated if DAS28 >3.2. Therapy started with methotrexate (MTX) with rapid escalation from 15mg to 25 mg per week. If activity persisted, a combination of up to 3 disease modifying drugs (DMARDs) was given, hydroxychloroquine and then leflunomide. If this failed (still DAS28 >3.2), treatment with biologic drugs was started as per NICE guidelines.
Results 37 of 108 patients have completed 1 year of treatment in the EAC. Female:male ratio was 2.7:1. At the first visit, 81% (30/37) patients were seropositive and 38% (14/37) had high disease activity, DAS >5.2. Results of treatment after 1 year in the EAC are shown in Table 1, as well as the type of treatment.
Conclusions Targeted protocol-driven treatment of early RA with rapid escalation of therapy with conventional DMARDs has resulted in remission in 63% and LDA in 81% of patients. Obtained in the real-life clinical setting, these outcomes are comparable to the ones reported in rigorous clinical trials . However, radiological outcomes remain to be analysed to see if this approach can also ameliorate bone erosions and joint damage.
NICE, February 2009. RA: The Management of RA in adults.
Disclosure of Interest None Declared
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