PT  - JOURNAL ARTICLE
AU  - van den Broek, M
AU  - Dirven, L
AU  - Klarenbeek, NB
AU  - Molenaar, THE
AU  - Han, KH
AU  - Kerstens, PJSM
AU  - Huizinga, TWJ
AU  - Dijkmans, BAC
AU  - Allaart, CF
TI  - The association of treatment response and joint damage with ACPA-status in recent-onset RA: a subanalysis of the 8-year follow-up of the BeSt study
AID  - 10.1136/annrheumdis-2011-200379
DP  - 2012 Feb 01
TA  - Annals of the Rheumatic Diseases
PG  - 245--248
VI  - 71
IP  - 2
4099  - http://ard.bmj.com/content/71/2/245.short
4100  - http://ard.bmj.com/content/71/2/245.full
SO  - Ann Rheum Dis2012 Feb 01; 71
AB  - Objective Anticitrullinated protein antibodies (ACPAs) are suggested to identify different subsets of patients with rheumatoid arthritis (RA). The authors compared the clinical and radiological responses to Disease Activity Score (DAS)-steered treatment in patients with RA positive or RA negative for ACPA. Methods In the BehandelStrategieën (BeSt) study, 508 patients with recent-onset RA were randomised to four treatment strategies aimed at a DAS ≤2.4. Risks of damage progression and (drug-free) remission in 8 years were compared for ACPA-positive and ACPA-negative patients using logistic regression analysis. Functional ability and DAS components over time were compared using linear mixed models. Results DAS reduction was achieved similarly in ACPA-positive and ACPA-negative patients in all treatment strategy groups, with a similar need to adjust treatment because of inadequate response. Functional ability and remission rates were not different for ACPA-positive and ACPA-negative patients. ACPA-positive patients had more radiological damage progression, especially after initial monotherapy. They had a lower chance of achieving (persistent) drug-free remission. Conclusion Clinical response to treatment was similar in ACPA-positive and ACPA-negative patients. However, more ACPA-positive patients, especially those treated with initial monotherapy, had significant radiological damage progression, indicating that methotrexate monotherapy and DAS- (≤2.4) steered treatment might be insufficient to adequately suppress joint damage progression in these patients.