Background NSAIDs are widely used in RA pts to control the main symptoms of the disease. However NSAIDs do not prevent RA progression and are associated with potential serious side effects. Therefore cutting down the use of NSAIDs leads to gastrointestinal (GI) and cardiovascular complications risk reduction, and should be considered as a criterion of efficacy.
Objectives To evaluate the need in NSAIDs and rate of GI complications in RA patients managed according to “Treat to Target” strategy.
Methods This study is a part of REMARCA program (abbreviation of Russian InvEstigation of MethotrexAte and biologics in eaRly aCtive inflammatory Arthritis). The study group included 141 RA patients (82.3% females and 17.7% males, mean age 50.3±12.8 y, disease duration 16,7±26,6 mo., including 51% of pts with disease duration of <6 mo.). The majority of pts had high disease activity (DAS28 5.5±1.14, SDAI 30,3±14,5), were RF-positive (88%) and ACPA-positive (86%). 127 pts (90%) were regularly taking NSIADs, 26 (18.4%) - glucocorticoids. 10 pts (7.0%) had the history of gastric and/or duodenal ulcer, 32 (22.7%) – dyspepsia, 61 (43.2%) - H.pylori infection. 12 (8.5%) were regularly taking proton pump inhibitors (PPI).
At the first stage of the study all pts were administered methotrexate injections (MTI), starting from 10 mg/week with further dose escalation up to 20-30 mg/week. To evaluate NSAIDs negative impact on upper GI tract all patients were subjected to upper GI tract endoscopy on enrollment and in 3 months after inclusion into the study.
Results Considerable improvement was documented in all pts after 3 mo of MTI therapy: a decrease in DAS28 to 4.08±1.46 (p<0,01), in SDAI - to 16.97±13.5 (p<0,01). The number of pts regularly taking NSAIDs reduced from 90% to 48.2%. Baseline upper GI tract endoscopy revealed gastric and/or duodenal ulcers in 7 (4.9%) pts, multiple (>10) gastric erosions - in 6 (4.3%) pts. Repeated endoscopic study in 3 mo after initiation of MTI did not find any ulcers, although multiple erosions were present in 3 (2.1%) pts.
Conclusions Methotrexate injections allow to considerably cut down the need in NSAIDs within 3 mo after initiation of therapy. Discontinuation of NSAIDs in early RA pts is associated with significant reduction of GI complications risk.
Disclosure of Interest None declared