Background Early remission is the key for preventing work disability (WD) in rheumatoid arthritis (RA) . Monitoring disease activity and targeting remission, as well as using initial combinations of disease modifying antirheumatic drugs (DMARDs) are the best ways to reach early remission.
Objectives To study separately the roles of targeted treatment and combination therapy in the prevention of WD days during 5 years after the diagnosis of RA.
Methods In the FIN-RACo trial, 162 patients, working or available to work, 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); after 2 years the treatments became unrestricted . 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 to be 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: 1 FIN-RACo+ACT, 2 FIN-RACo+non-ACT, 3 SINGLE+ACT, and 4 SINGLE+non-ACT and analysed the cumulative WD days up to 5 years in these sub-groups.
Results The cumulative WD days in different groups throughout the 5-year follow-up are presented in Figure. Their numbers by groups were as follows: 1: 222; 2: 470; 3: 491; 4: 650 (age, sex adjusted p<0.001).
Conclusions In early RA, targeted treatment and combination-DMARD therapy are equally and additively important for preventing WD.
Puolakka et al. Arthritis and rheumatism. 2005;52:36-41.
Möttönen et al. Lancet. 1999;353:1568-73.
Disclosure of Interest None Declared