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  • Remission induction therapy with methotrexate and prednisone in patients with early rheumatoid and undifferentiated arthritis (the IMPROVED study)

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Clinical and epidemiological research
Extended report
Remission induction therapy with methotrexate and prednisone in patients with early rheumatoid and undifferentiated arthritis (the IMPROVED study)
  1. Kirsten Wevers-de Boer1,
  2. Karen Visser1,
  3. Lotte Heimans1,
  4. H Karel Ronday2,
  5. Esmeralda Molenaar3,
  6. J Hans L M Groenendael4,
  7. André J Peeters5,
  8. Marie-Louise Westedt6,
  9. Gerard Collée7,
  10. Peter B J de Sonnaville8,
  11. Bernard A M Grillet9,
  12. Tom W J Huizinga1,
  13. Cornelia F Allaart1
  1. 1Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Department of Rheumatology, HAGA Hospital, the Hague, The Netherlands
  3. 3Department of Rheumatology, Groene Hart Hospital, Gouda, The Netherlands
  4. 4Department of Rheumatology, Franciscus Hospital, Roosendaal, The Netherlands
  5. 5Department of Rheumatology, Reinier de Graaf Gasthuis, Delft, The Netherlands
  6. 6Department of Rheumatology, Bronovo Hospital, the Hague, The Netherlands
  7. 7Department of Rheumatology, MCH, the Hague, The Netherlands
  8. 8Department of Rheumatology, Admiraal de Ruyter Hospital, Goes, The Netherlands
  9. 9Department of Rheumatology, Zorgsaam Hospital, Terneuzen, The Netherlands
  1. Correspondence to Kirsten Wevers-de Boer, Department of Rheumatology, Leiden University Medical Center, Leiden, PO BOX 9600, 2300 RC Leiden, The Netherlands; K.V.C.de_boer{at}lumc.nl

Abstract

Aim Classifying more patients as rheumatoid arthritis (RA) (2010 American College of Rheumatology/European League Against Rheumatism criteria for RA) may improve treatment outcomes but may cause overtreatment in daily practice. The authors determined the efficacy of initial methotrexate (MTX) plus prednisone treatment in patients with 1987 or 2010 classified RA and undifferentiated arthritis (UA).

Method 610 recent onset RA or UA patients started with MTX 25 mg/week and prednisone 60 mg/day tapered to 7.5 mg/day in 7 weeks. Percentage remissions after 4 months were compared between RA (1987 or 2010 criteria) and UA. Predictors for remission were identified.

Results With the 2010 criteria, 19% more patients were classified as RA than with the 1987 criteria, but similar remission rates were achieved: 291/479 (61%) 2010 classified RA and 211/264 (58%) 1987 classified RA patients (p=0.52), and 79/122 (65%) UA patients (p=0.46). Anticitrullinated protein antibodies (ACPA) positive RA patients achieved more remission (66%) than ACPA negative RA patients (51%, p=0.001), but also had a lower mean baseline Disease Activity Score (DAS) (3.2 vs 3.6, p<0.001). Independent predictors for remission were male sex, low joint counts, DAS and Health Assessment Questionnaire, low body mass index and ACPA positivity.

Conclusion Initial treatment with MTX and a tapered high dose of prednisone results in similarly high remission percentages after 4 months (about 60%) in RA patients, regardless of fulfilling the 1987 or 2010 criteria, and in UA patients. Independent predictors indicate that initiating treatment while disease activity is relatively low results in more remission.

https://doi.org/10.1136/annrheumdis-2011-200736

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    Footnotes

    • Funding The study was designed by the investigators and financially supported by Abbott. Data collection, trial management, data collection, data analysis and preparation of the manuscript were performed by the authors.

    • Competing interests None.

    • Patient consent Obtained.

    • Ethics approval Approval provided by the Medical Ethics Committees of all participating hospitals.

    • Provenance and peer review Not commissioned; externally peer reviewed.