RT Journal Article
SR Electronic
T1 A tight control treatment strategy aiming for remission in early rheumatoid arthritis is more effective than usual care treatment in daily clinical practice: a study of two cohorts in the Dutch Rheumatoid Arthritis Monitoring registry
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 845
OP 850
DO 10.1136/annrheumdis-2011-200274
VO 71
IS 6
A1 Lydia G Schipper
A1 Marloes Vermeer
A1 Hillechiena H Kuper
A1 Monique O Hoekstra
A1 Cees J Haagsma
A1 Alfons A Den Broeder
A1 Piet van Riel
A1 Jaap Fransen
A1 Mart AFJ van de Laar
YR 2012
UL http://ard.bmj.com/content/71/6/845.abstract
AB There is strong evidence from clinical trials that a ‘treat to target’ strategy is effective in reaching remission in rheumatoid arthritis (RA). However, the question is whether these results can be translated into daily clinical practice and clinical remission is a reachable target indeed. Objective The study aims to investigate whether in early RA a treatment strategy aiming at Disease Activity Score (DAS) 28 <2.6 is more effective than ‘usual care’ treatment for reaching clinical remission after 1 year. Methods Two early RA inception cohorts from two different regions including patients who fulfilled the American College of Rheumatology criteria for RA were compared. Patients in the tight-control cohort (n=126) were treated according to a DAS28-driven step-up treatment strategy starting with methotrexate, addition of sulphasalazine (SSZ) and exchange of SSZ by anti-tumour necrosis factor in case of failure. Patients in the usual-care cohort (n=126) were treated with methotrexate or SSZ, without DAS28-guided treatment decisions. The primary outcome was the percentage remission (DAS28<2.6) at 1 year. Time to first remission and change in DAS28 were secondary outcomes. Results After 1 year, 55% of tight-control patients had a DAS28<2.6 versus 30% of usual care patients (OR 3.1, 95% CI 1.8 to 5.2). The median time to first remission was 25 weeks for tight control and more than 52 weeks for usual care (p<0.0001). The DAS28 decreased with −2.5 in tight control and −1.5 in usual care (p<0.0001). Conclusion In early RA, a tight control treatment strategy aiming for remission leads to more rapid DAS28 remission and higher percentages of remission after 1 year than does a usual care treatment.