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Drug-free remission, functioning and radiographic damage after 4 years of response-driven treatment in patients with recent onset rheumatoid arthritis
  1. Sjoerd M Van Der Kooij (smvanderkooij{at}
  1. LUMC, Netherlands
    1. Yvonne PM Goekoop-Ruiterman (y.p.m.goekoop{at}
    1. Leiden University Medical Center, Netherlands
      1. Jeska K De Vries-Bouwstra (jkdevriesbouwstra{at}
      1. VUmc, Netherlands
        1. Melek Guler-Yuksel (m.yuksel{at}
        1. Leiden University Medical Center, Netherlands
          1. Aeilko H Zwinderman
          1. AMC, Netherlands
            1. Pit JSM Kerstens (p.kerstens{at}
            1. Jan van Breemen, Netherlands
              1. Peter AHM Van Der Lubbe
              1. Vlietland Hospital, Netherlands
                1. Willem M De Beus
                1. MCH, Netherlands
                  1. Bernard AM Grillet
                  1. Hospital Zeeuws Vlaanderen, Netherlands
                    1. Karel Ronday
                    1. Haga Hospital, Netherlands
                      1. Tom WJ Huizinga (t.w.j.huizinga{at}
                      1. Leiden University Medical Center, Netherlands
                        1. Ferdinand C Breedveld (f.c.breedveld{at}
                        1. University Hospital Leiden, Netherlands
                          1. Ben AC Dijkmans
                          1. VU Medical Center, Netherlands
                            1. Cornelia F Allaart (c.f.allaart{at}
                            1. LUMC, Netherlands


                              Objectives: To compare the occurrence of drug-free remission, functional ability and radiological damage after 4 years of response-driven treatment according to 4 different treatment strategies for rheumatoid arthritis (RA).

                              Methods: Patients with recent onset, active RA (n=508) were randomized to 4 different treatment strategies: (1) sequential monotherapy; (2) step-up combination therapy; (3) initial combination therapy with prednisone; and (4) initial combination therapy with infliximab. Treatment was adjusted based on three-monthly disease activity score (DAS) assessments, aiming at a DAS ≤2.4. From the third year, patients with a sustained DAS <1.6 discontinued treatment.

                              Results: In total, 43% of patients were in remission (DAS <1.6) at 4 years, and 13% were in drug-free remission: 14, 12, 8 and 18% of patients in groups 1-4, respectively. Absence of anti-cyclic citrullinated peptide antibodies, male gender and short symptom duration were independently associated with drug-free remission. Functional ability and remission were maintained in all 4 groups with the continuation of DAS-driven treatment, without significant differences between the groups. Significant progression of joint damage was observed in 38% and 31% of patients in groups 3 and 4 versus 51% and 54% of patients in groups 1 and 2 (P<0.05, group 4 versus groups 1 and 2, group 3 versus group 2).

                              Conclusions: In patients with recent onset active RA, drug-free remission was achieved in up to 18% of patients. DAS-driven treatment maintained clinical and functional improvement, independent of the treatment strategy. Joint damage progression remained significantly lower after initial combination therapy compared with initial monotherapy.

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