Table 6

Delayed DMARD treatment trials in early RA

Author (reference)Study designMean disease duration (months)TreatmentOutcomeEvidence 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 al73Randomised, placebo controlled trial; 23 patients, 18 month study8Intramuscular gold v 6 or 12 month delay of treatmentSignificantly reduced x ray progression at 6 and 12 monthsIb
Egsmose et al74Double blind, randomised, placebo controlled trial; 75 patients, 60 month study11Oral gold v delayed treatment of 8 or 12 monthsEarly treatment significantly reduced swollen joint counts, HAQ, and x ray progressionIb
Munro et al75Prospective trial of 440 patients; 60 month study0–24 24–60 60+Intramuscular goldSignificant reduction of HAQ in the 0–24 month groupIII
Tsakonas et al76Prospective trial of 119 patients; 45 month study9Hydroxychloroquine v delayed treatment of 9 monthsEarly treatment group showed greater improvement in pain index, functional ability, and RA global wellbeingIII
van der Heide et al77Open, randomised trial; 238 patients, 12 month study<12IM gold, hydroxychloroquine or methotrexateEarly treatment group had significantly reduced swollen and tender joints, HAQ, ESR, and painIb