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Probability of continued low disease activity in patients with recent onset rheumatoid arthritis treated according to the disease activity score


Objective: To assess the duration and the probability of maintaining low disease activity once a low disease activity score (DAS) is achieved in recent onset rheumatoid arthritis (RA) patients.

Methods: The BeSt study is a randomised trial comparing four different treatment strategies in patients with recent onset, active RA. Treatment adjustments were mandatory as long as the DAS was >2.4. If the DAS was ⩽2.4, treatment was continued and after 6 months, tapered to maintenance dose. We analysed thrice-monthly DAS calculations in order to assess the duration and the probability of maintaining a DAS ⩽2.4.

Results: Patients treated with initial combination therapy achieved a DAS ⩽2.4 significantly earlier than patients treated with initial monotherapy. Independent of treatment strategy and without treatment adjustments, the probability of a next DAS ⩽2.4 3 months after a first DAS ⩽2.4 was 74%. The probability increased to 85% after two preceding DAS ⩽2.4 and to 88–97% after one to two preceding DAS<1.6. The median duration of a DAS ⩽2.4 was 12 months.

Conclusion: Once recent onset RA patients achieve a low DAS, the probability of maintaining a low DAS without treatment adjustments is high. This may have implications for the monitoring of patients in daily practice.

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