Background Most patients with rheumatoid arthritis (RA) achieve remission, have marginal radiographic progression and sustain normal function when an initial aggressive combination treatment with three disease modifying antirheumatic drugs (DMARDs) and prednisolone is used, with or without early biologics [1,2].
Objectives To study whether the time of the first strict ACR remission correlates with the consequent long-term disease activity in early, aggressively treated RA patients.
Methods A total of 99 patients with early (< 1 year), DMARD-naïve, active RA were treated with a combination of methotrexate, sulfasalazine, hydroxychloroquine, and prednisolone, and randomized to blindly receive either infliximab or placebo infusions during the first 6 months. After 24 months, if the patient was in remission, the treatments could be tapered down, and, in the case of flare-up, increased, with strict ACR remission as a goal. Subgroups were generated according to the time of the first ACR remission: 1: within 3 months (n=31), 2: within 6 months (n=28), 3: within 18 months (n=15), 4: after 18 months or not at all (n=19), and the area under curve between 2-5 years for disease activity score applying 28 joints (DAS28-AUC2-5y) was studied.
Results A total of 93 patients (94%) were followed up for 60 months. The mean (SD) DAS28-AUC2-5y was: 1.55 (0.59) in group 1; 1.53 (0.62) in group 2; 1.91 (0.55) in group 3; and 2.29 (1.04) in group 4 (age, sex, RF, DAS28 at baseline adjusted p=0.0032).
Conclusions In early RA, targeted treatment with a combination of DMARDs and prednisolone produces excellent long-term outcomes in most patients, with the mean disease activity below the remission limit in all patients. However, strict remission within 6 months predicts the lowest sustained disease activity.
Leirisalo-Repo et al. Ann Rheum Dis 2012 Jun 30 [Epub ahead of print]
Rantalaiho V et al. Ann Rheum Dis 2012;71(Suppl 3): 103.
Disclosure of Interest None Declared