Delayed DMARD treatment trials in early RA
| Author (reference) | Study design | Mean disease duration (months) | Treatment | Outcome | Evidence category |
|---|---|---|---|---|---|
| HAQ, Health Assessment Questionnaire; ESR, erythrocyte sedimentation rate. | |||||
| Adapted from Quinn, Conaghan, and Emery. The therapeutic approach of early intervention for rheumatoid arthritis (submitted). | |||||
| Buckland-Wright et al73 | Randomised, placebo controlled trial; 23 patients, 18 month study | 8 | Intramuscular gold v 6 or 12 month delay of treatment | Significantly reduced x ray progression at 6 and 12 months | Ib |
| Egsmose et al74 | Double blind, randomised, placebo controlled trial; 75 patients, 60 month study | 11 | Oral gold v delayed treatment of 8 or 12 months | Early treatment significantly reduced swollen joint counts, HAQ, and x ray progression | Ib |
| Munro et al75 | Prospective trial of 440 patients; 60 month study | 0–24 24–60 60+ | Intramuscular gold | Significant reduction of HAQ in the 0–24 month group | III |
| Tsakonas et al76 | Prospective trial of 119 patients; 45 month study | 9 | Hydroxychloroquine v delayed treatment of 9 months | Early treatment group showed greater improvement in pain index, functional ability, and RA global wellbeing | III |
| van der Heide et al77 | Open, randomised trial; 238 patients, 12 month study | <12 | IM gold, hydroxychloroquine or methotrexate | Early treatment group had significantly reduced swollen and tender joints, HAQ, ESR, and pain | Ib |