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A good response to early DMARD treatment of patients with rheumatoid arthritis in the first year predicts remission during follow up
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  1. S M M Verstappen1,
  2. G A van Albada-Kuipers2,
  3. J W J Bijlsma1,
  4. A A M Blaauw1,
  5. Y Schenk3,
  6. H C M Haanen4,
  7. J W G Jacobs1,
  8. on behalf of the Utrecht Rheumatoid Arthritis Cohort Study group (SRU)
  1. 1University Medical Centre Utrecht, Utrecht, the Netherlands
  2. 2Meander Medical Centre, Amersfoort, the Netherlands
  3. 3Diakonessenhuis, Utrecht
  4. 4Antonius Hospital, Nieuwegein, the Netherlands
  1. Correspondence to:
    Dr S M M Verstappen
    University Medical Centre Utrecht, Department of Rheumatology and Clinical Immunology, F02.127, PO Box 85500, 3508 GA Utrecht, Netherlands; s.verstappenazu.nl

Abstract

Objective: To describe the frequency and duration of remission in the Utrecht rheumatoid arthritis cohort of patients followed since diagnosis, and the clinical and treatment characteristics of patients with remission v those without.

Methods: In 1990 the Utrecht rheumatoid arthritis cohort study group started a clinical trial in which patients with recent onset of rheumatoid arthritis (<1 year) were randomised into four treatment groups: hydroxychloroquine (n = 169); intramuscular gold (n = 163); methotrexate (n = 166); and pyramid (n = 64). After two years, rheumatologists were allowed to prescribe any disease modifying antirheumatic drug. Remission was defined as: duration of morning stiffness ⩽15 min, mean VAS pain ⩽10 mm, Thompson joint score ⩽10, and ESR ⩽30 mm/h during at least six months. Cox regression analysis was used to determine baseline clinical, demographic, and treatment predictors of remission.

Results: Mean follow up duration was 62 months. Thirty six per cent achieved at least one period of remission. Median duration between diagnosis and the first remission period was 15 months for the intramuscular gold group, 18 months for the methotrexate and hydroxychloroquine groups, and 24 months for the pyramid group (NS). Predictors of remission were early response to initial treatment, less pain, rheumatoid factor negativity, and lower joint score at baseline.

Conclusions: After a mean follow up duration of 62 months, only 36% of the patients had fulfilled the remission criteria at least once. A good response to treatment during the first year seems to be independently associated with remission rather than initial treatment alone.

  • ACR, American College of Rheumatology
  • DMARD, disease modifying antirheumatic drug
  • HAQ, health assessment questionnaire
  • RF, rheumatoid factor
  • VAS, visual analogue scale
  • disease modifying antirheumatic drug
  • remission
  • rheumatoid arthritis
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Footnotes

  • We would like to thank all the other participating rheumatologists of the Utrecht Rheumatoid Arthritis Cohort study group; C van Booma-Frankfort (Diakonessenhuis, Utrecht), E J ter Borg (Antonius Hospital, Nieuwegein), A H M Heurkens (Meander Medical Centre, Amersfoort), D M Hofman (Hilversum Hospital, Hilversum), A A Kruize (UMC Utrecht, Utrecht), M J van der Veen (St Jansdal, Harderwijk), and C M Verhoef (Flevo hospital, Almere), Netherlands.

    This study was supported by a grant from The Dutch Arthritis Association

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