Objectives: To compare the efficacy of disease activity score (DAS)-driven therapy and routine care in patients with recent-onset rheumatoid arthritis.
Methods: Patients with recent-onset rheumatoid arthritis receiving traditional antirheumatic therapy from either the BeSt study, a randomized controlled trial comparing different treatment strategies (group A) or 2 Early Arthritis Clinics (group B) were included. In group A, systematic DAS-driven treatment adjustments aimed to achieve low disease activity (DAS ≤2.4). In group B, treatment was left to the discretion of the treating physician. We evaluated functional ability (HAQ), disease activity score in 28 joints (DAS28) and Sharp/van der Heijde radiographic score (SHS).
Results: At baseline, patients in group A (n=234) and group B (n=201) had comparable demographic characteristics and a mean HAQ of 1.4. Group A had a longer median disease duration than group B (0.5 vs 0.4 year, p=0.016), a higher mean DAS28 (6.1 vs 5.6, p<0.001), more rheumatoid factor positive patients (66% vs 42%, p<0.001) and more erosive patients (71% vs 53%, p<0.001). After 1 year, the HAQ improvement was 0.7 vs 0.5 (p=0.029), and the percentage in remission (DAS28<2.6) 31% vs 18% (p<0.005) in groups A and B, respectively. In group A, the median SHS progression was 2.0 (expected progression 7.0), in group B, the SHS progression was 1.0 (expected progression 4.4).
Conclusions: In patients with recent onset rheumatoid arthritis receiving traditional therapy, systematic DAS-driven therapy results in significantly better clinical improvement and possibly improves the suppression of joint damage progression.