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Current strategies in rheumatoid arthritis (RA) management aim at diagnosing patients and starting disease-modifying antirheumatic drug (DMARD) treatment very early to optimise outcome. International guidelines recommend the initial use of conventional synthetic disease-modifying drugs, especially methotrexate (MTX),1 even though it has recently been demonstrated that early addition of biologics to the therapeutic regimen with MTX can optimise response.2 The prevention of functional deterioration is an important treatment goal from both patient and societal perspectives. Previous studies in patients with early RA,3 and in patients with established RA,4 demonstrated that large joint involvement is strongly associated with functional impairment and with mortality in long-term observational cohorts.5
This post hoc analysis of the U-Act-Early trial was conducted to examine in a cohort of patients with very early RA the impact of large joint involvement (LJI) on disease activity and functional capacity over time. In this trial, 317 patients from 21 Dutch centres were randomised to start treatment with either MTX or …
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