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THU0071 Radiographic progression in early rheumatoid arthritis patients following initial combination versus step-up treat to target therapy in daily clinical practice: results from the dream registry
  1. LM Steunebrink1,
  2. GA Versteeg2,
  3. HE Vonkeman1,
  4. PM ten Klooster3,
  5. M Hoekstra4,
  6. MA van de Laar1
  1. 1Arthritis Center Twente, Department of Rheumatology, Department Psychology, Health & Technology, Medisch Spectrum Twente, University of Twente
  2. 2Arthritis Center Twente, Department of Rheumatology, Department Psychology, Health & Technology, Medisch Spectrum Twente, University of Twente
  3. 3Department Psychology, Health & Technology, University of Twente, Enschede
  4. 4Department of Rheumatology, Isala, Zwolle, Netherlands


Background Early and aggressive targeted treatment with disease modifying anti-rheumatic drugs (DMARDs) has been shown to lead to substantial reductions in disease activity (1,2) and radiologic damage in patients with early rheumatoid arthritis (RA) (3,4).

Objectives The aim of this study was to compare the first-year radiographic progression rates between a treat-to-target (T2T) strategy with initial combination therapy (strategy II) versus an initial step-up monotherapy (strategy I).

Methods A total of 128 patients from strategy II was individually matched with 128 patients from strategy I on sex, age (± 5 yrs.) and baseline disease activity (± 0.5 on the DAS28). Differences in radiographic progression scores and the number of patients experiencing a minimal clinically important difference (≥5 SHS points; MCID) between both strategies were tested with Mann Whitney U test and chi-square test. Next, linear and logistic regression analyses were performed to examine which baseline variables were associated with radiographic progression scores and the probability of experiencing an MCID within 1 year.

Results Patients with initial combination therapy had slightly higher baseline disease activity scores and pain scores, but better mental health scores. Patients with initial monotherapy had significantly more, and more frequently clinically relevant, radiographic progression after one year. Experiencing a MCID was associated with fewer tender joints (p=0.05) and higher ESR (p=0.02) at baseline.

Conclusions Excellent radiographic outcome was achieved for patients treated according to a protocolled T2T strategy in daily clinical practice. Patients treated with initial monotherapy had significantly more short-term radiographic progression than patients treated with initial combination therapy.


  1. Steunebrink LMM, Vonkeman HE, ten Klooster PM, et al. (2016) Recently diagnosed rheumatoid arthritis patients benefit from a treat-to-target strategy: results from the DREAM registry. Clin Rheumatol 35:609–615. doi: 10.1007/s10067–016–3191–3.

  2. Steunebrink LMM, Versteeg GA, Vonkeman HE, et al. (2015) Initial combination therapy versus step-up therapy in treatment to the target of remission in daily clinical practice in early rheumatoid arthritis patients: results from the DREAM registry. Arthritis Res Ther 18:60. doi: 10.1186/s13075–016–0962–9.

  3. Stenger AA, Van Leeuwen MA, Houtman PM, et al. (1998) Early effective suppression of inflammation in rheumatoid arthritis reduces radiographic progression. Br J Rheumatol 37:1157–63.

  4. Goekoop-Ruiterman YPM, de Vries-Bouwstra JK, Allaart CF, et al. (2008) Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): A randomized, controlled trial. Arthritis Rheum 58:S126–35. doi: 10.1002/art.23364.


Acknowledgements We would like to thank all the patients, rheumatology nurses, and rheumatologists who participated in our study.

Disclosure of Interest None declared

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