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  • Physicians' adherence to tight control treatment strategy and combination DMARD therapy are additively important for reaching remission and maintaining working ability in early rheumatoid arthritis: a subanalysis of the FIN-RACo trial

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Physicians' adherence to tight control treatment strategy and combination DMARD therapy are additively important for reaching remission and maintaining working ability in early rheumatoid arthritis: a subanalysis of the FIN-RACo trial
  1. Vappu Rantalaiho1,
  2. Hannu Kautiainen2,3,
  3. Markku Korpela1,
  4. Kari Puolakka4,
  5. Harri Blåfield5,
  6. Kirsti Ilva6,
  7. Pekka Hannonen7,
  8. Marjatta Leirisalo-Repo8,9,
  9. Timo Möttönen10,
  10. for the FIN-RACo Study Group
  1. 1 Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital, Tampere, Finland
  2. 2 Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland
  3. Department of General Practice, University of Helsinki, Helsinki, Finland
  4. 3 Unit of Primary Health Care, Turku University Hospital, Turku, Finland
  5. 4 South-Karelia Central Hospital, Lappeenranta, Finland
  6. 5 Department of Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
  7. 6 Department of Medicine, Hämeenlinna Central Hospital, Hämeenlinna, Finland
  8. 7 Department of Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland
  9. 8 Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, Helsinki, Finland
  10. 9 Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
  11. 10 Department of Medicine, Division of Rheumatology, Turku University Hospital, Turku, Finland
  1. Correspondence to Dr Vappu Rantalaiho, Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital, PO BOX 2000, Tampere FI-33521, Finland; vappu.rantalaiho{at}pshp.fi

https://doi.org/10.1136/annrheumdis-2013-204271

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    Ample evidence shows that both monitoring disease activity and aiming at remission,1–4 as well as using combinations of disease modifying antirheumatic drugs (DMARDs), are effective treatment strategies in early rheumatoid arthritis (RA).5–8 Still, some authorities stress the former, but ignore the latter.9

    In the FIN-RACo trial, 195 patients with early, active RA were randomised for a 2-year treatment with either a triple-combination of DMARDs and prednisolone (FIN-RACo) or DMARD monotherapy and discretionary prednisolone (SINGLE); both drug treatment strategies aimed at strict remission.6 Thus, in case of active disease, all inflamed joints had to be injected with glucocorticoids and predefined DMARD treatment adjustments made. After 2 years, remission was more common in the FIN-RACo than in the SINGLE group (37% vs 18%), and in a multivariate analysis only the treatment strategy proved to predict remissions at 2 years.6 Further, at 5 years, work disability (WD) was less common in the FIN-RACo than in the SINGLE group, especially regarding the patients who had reached remission at 6 months.10

    In these subanalyses we wanted to study separately the roles of targeted treatment and combination DMARD …

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    Footnotes

    • Contributors All authors contributed to the conception and design of the study and participated in the analysis and interpretation of the data. VR drafted the article and the other authors revised it critically for intellectual content. All authors approved the final version of this article.

    • Funding The Competitive Research Funding of the Tampere University Hospital (Grants 9M124 and 9M128) and the Orion-Farmos Research Foundation Financing have supported the present study by funding the salary for VR during the preparation of the manuscript.

    • Competing interests VR has received honoraria from Abbvie, BMS, Pfizer, Roche and UCB Pharma. HK has received honoraria from Abbvie, Pfizer and Schering-Plough. MK has received honoraria and consulting fees from Abbvie, BMS, GSK, MSD, Pfizer, Roche and UCB Pharma. KP has received honoraria and consulting fees from Abbvie, BMS, MSD Finland, Pfizer and UCB Pharma. PH has received honoraria and consulting fees from Abbott, Astra-Zeneca, BMS, GSK, MSD Finland, Mundipharma, Pfizer, Roche and UCB Pharma. ML-R has received honoraria and consulting fees from Abbott, BMS, GSK, MSD, Pfizer, Roche, Schering-Plough and UCB Pharma. TM has received honoraria and consulting fees from Abbott, Amgen, Astra, BMS, Ely Lilly, GSK, MSD, Pfizer, Schering-Plough, Servier, Roche and UCB Pharma. HB and KI have nothing to disclose.

    • Ethics approval The ethics committees of all participating hospitals approved the study.

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