Objectives To examine the treatment outcome at 1 year of patients treated with tight control of the disease in a prospective cohort of patients with newly diagnosed rheumatoid arthritis (RA).
Methods All patients with newly diagnosed RA according to the 2010 ACR/EULAR classification criteria between 2010 and 2011 were studied. Demographic data, clinical presentation, prognostic factors (family history, rheumatoid factor and anti-cyclic citrullinated peptide antibody status, radiographic joint erosion) were recorded at baseline visit and then every 3 months. Disease activity score (DAS-28) was calculated every 3 months and recorded prospectively. Addition or shifting of conventional DMARDs was done according to predefined treatment protocol whenever DAS-28 >3.2 during each visit. The predefined escalating regimen was as follows, (1) methotrexate monotherapy, (2) combination of methotrexate and sulphasalazine or hydroxychloroquine, (3) combination of methotrexate and leflunomide, (4) biological therapies. Treatment response and complete remission rate according to the ACR and EULAR response criteria were calculated at 1 year. The treatment received at last visit was recorded and the proportion of patients receiving biological therapy was compared to the historical cohort of established RA patients in the same center.
Results 127 newly diagnosed RA patients were recruited during the study period. Of which, 49 patients (75% women) had completed the 12 months study. The mean age of RA diagnosis was 45.1±11.6 years. The mean time interval between onset of symptom and diagnosis was 6.72±5.1 months. 31 (63.2%) patients and 17 (34.6%) were positive for rheumatoid factors and anti-cyclic citrullinated peptide antibody respectively. Baseline radiographic joint erosion was present in 11 (22.4%). The mean DAS-28 was significantly improved after 1 year of treatment (4.9±1.2 vs 3.7±1.1; p<0.001). The percentage of patients achieved clinical remission (DAS 28 <2.6) and low disease activity (DAS-28, 2.6-3.2) at 3 month, 6 months, 9 months, 12 months were 14.2% and 12.2%, 20.4% and 10.2%, 22.4% and 14.2%, 24.7% and 16.3%, respectively. Good and moderate EULAR response was achieved at 3 months, 6 months, 9 months, 12 months in 14.2% and 36.7%, 12.2% and 46.9%, 18.3% and 48.9%, 24.4% and 53.1% respectively. At last visit, the number of DMARD used by patients was 4 in 2 (4.1%) patients, 3 in 11 (22.4%) patients, 2 in 22 (44.8%) and 1 in 14 (28.5%) respectively. The conventional DMARDs used was methotrexate in 38 (77.5%) patients, sulphasalazine in 18 (36.7%) patients, hydroxychloroquine in 24 (48.9%) patients, leflunomide in 10 (20.4%) patients. 5 (10.2%) patients required the use of biological therapies for disease control at 12 months (3 etanercept, 1 infliximab, 1 adalimumab). In comparison to the proportion of established RA patients treated with biological therapies in the same unit [200 (19.1%) out of 1049 patients], much less frequent biological therapy was required in early RA patients treated in the early arthritis clinic (19.1% vs 10.2%).
Conclusions Use of biological therapy could be minimized by tight control of disease activity with conventional DMARDs in achieving substantial rate of clinical remission and low disease activity in early RA patients.
Disclosure of Interest None Declared
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