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THU0149 Treat to target early rheumatoid arthritis clinic: High rates of remission and low disease activity on treatment with conventional disease modifying drugs
  1. O. Semenova1,
  2. H. Thompson1,
  3. S. Kallankara1,
  4. O. Olabambo1,
  5. Y. Patel1,2,
  6. E. Baguley1
  1. 1Rheumatology, Hull Royal Infirmary
  2. 2Hull and York Medical School, University of Hull, Hull, United Kingdom

Abstract

Background The Early Rheumatoid Arthritis Clinic (EAC) was established in 2010 to meet NICE recommendations (2009) for treatment of early rheumatoid arthritis [1].

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.

Table 1. After 1 year in the Early Arthritis Clinic

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 [2]. However, radiological outcomes remain to be analysed to see if this approach can also ameliorate bone erosions and joint damage.

  1. NICE, February 2009. RA: The Management of RA in adults.

  2. Lancet 2008;37:375-82

Disclosure of Interest None Declared

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