Background Finnish national combination treatment trials [1, 2] have demonstrated excellent outcomes in patients with (ERA) including 90% of patients reaching DAS28 remission at 6 months. Whether similar results are reached in clinical praxis is not known.
Objectives We describe characteristics, disease activity, and DAS28-remission rates at 3 months in ERA patients treated in 5 Finnish outpatient clinics.
Methods FIN-ERA is the first national multicenter observational cohort of adult patients with early inflammatory arthritis clinically diagnosed as RA between Oct 2011 and Sep 2014. Data comprising demographic, clinical and treatment characteristics were collected as a part of routine care. Treatment decisions were made by treating rheumatologists with cooperation with the patient at each clinic. Finnish treatment recommendations emphasize early and active therapy with csDMARDs and prednisolone starting at the diagnosis, and unlimited glucocorticoid injections to all swollen joints.
Results Out of 605 recruited patients, 586 completed baseline and 3 months visit and had full data for disease activity score (DAS28-3) with ESR. In the entire cohort, the mean age was 56±16 yrs, the median (IQR) duration of symptoms was 6 (3,11) mo, rheumatoid factor (RF) and anti cyclic-citrullinated peptide antibodies (anti-CCP) were positive in 68% (data for N=569) and 69% (data for N=584), respectively. Twenty three percent of patients had radiographic erosions at baseline. A total of 498 (85%) fulfilled the ACR/EULAR 2010 classification criteria for RA. Figure 1 represents the mean DAS28-3 at baseline and at 3 mo at FIN-ERA clinics A-E. The respective mean HAQ and DAS28 (with ESR, 4 variables,DAS28-4) were 0.4±0.5 (data for N=431) and 2.2±1.0 (data for N=457). A total of 68% (data for N=457) met DAS28-4 remission at 3 mo. Remission rates were similar in patients classified as undifferentiated arthritis (15% of the cohort).DAS28-4 remission rates at sites A-E were 75% (data for N=188), 64% (data for N=78), 70% (Data for N=54), 61% (Data for N=54) and 60% (data for N=83).
Conclusions Two thirds of ERA patients reach early DAS28 remission in Finland at 3 months.
Möttönen T, et al. Comparison of combination therapy with single-drug therapy in early rheumatoid arthritis: A randomised trial. FIN-RACo trial group. Lancet 1999
Leirisalo-Repo M, et al. Infliximab for 6 months added on combination therapy in early rheumatoid arthritis: 2-year results from an investigator-initiated, randomised, double-blind, placebo-controlled study (the NEO-RACo Study). Ann Rheum Dis 2012.
Acknowledgements We would like to thank study nurses L. Miina, S. Sarakari, M.Lemmetty, K.Arvola, and T.Reini.
This study was supported by Pfizer.
Disclosure of Interest None declared