Background Multiple trials have shown that in early rheumatoid arthritis (RA), both monitoring disease activity and aiming at remission, as well as using combinations of disease modifying antirheumatic drugs (DMARDs) are effective treatment strategies [1, 2]. Still, many authorities stress the former, but ignore the latter.
Objectives To study separately the roles of targeted treatment and combination therapy on the 2-year remission rates of early RA.
Methods In the FIN-RACo trial, 195 patients with early, active RA were randomized to be treated for 2 years either with a triple-combination of DMARDs and prednisolone (PRD) (FIN-RACo), or with DMARD monotherapy and discretionary PRD (SINGLE) . Throughout the follow-up the treatment was aimed at strict ACR remission so that in continuous disease activity all inflamed joints were to be injected with glucocorticoids and predefined treatment adjustments made. However, further analyses have shown heterogeneity in the activity of the participating physicians. Here we divided them into active (ACT) and non-active (non-ACT) as per their fidelity to following the protocol. According to the original randomization group and the physician’s activity, we then formed 4 groups of patients: FIN-RACo+ACT, FIN-RACo+non-ACT, SINGLE+ACT, and SINGLE+non-ACT and analysed the strict ACR-remission rates at 6, 12, and 24 months in these sub-groups.
Results A total of 178 patients (91%) were followed up for 2 years. The strict remission rates at 6, 12, and 24 months are presented in Figure. In a logistic regression analysis for the odds of being in remission at 2 years, only FIN-RACo treatment (OR 2.8, 95% CI: 1.4 to 5.5) and physician’s activity (OR 2.3, 95% CI: 1.2 to 5.0) were significant, while age, sex, rheumatoid factor positivity, or baseline disease activity were not.
Conclusions In early RA, targeted treatment and combination DMARD therapy are equally and additively important for reaching remission.
Möttönen et al. Lancet. 1999;353:1568-73.
Klarenbeek et al. Ann Rheum Dis. 2011;70:1039-46.
Disclosure of Interest None Declared