Early combination disease-modifying antirheumatic drug therapy and tight disease control improve long-term radiologic outcome in patients with early rheumatoid arthritis: the 11-year results of the Finnish Rheumatoid Arthritis ComReportar como inadecuado




Early combination disease-modifying antirheumatic drug therapy and tight disease control improve long-term radiologic outcome in patients with early rheumatoid arthritis: the 11-year results of the Finnish Rheumatoid Arthritis Com - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Arthritis Research and Therapy

, 12:R122

First Online: 24 June 2010Received: 26 October 2009Revised: 18 February 2010Accepted: 24 June 2010

Abstract

IntroductionEarly treatment of rheumatoid arthritis RA has been shown to retard the development of joint damage for a period of up to 5 years. The aim of this study was to evaluate the radiologic progression beyond that time in patients with early RA initially treated with a combination of three disease-modifying antirheumatic drugs DMARDs or a single DMARD.

MethodsA cohort of 199 patients with early active RA were initially randomized to receive treatment with a combination of methotrexate, sulfasalazine, and hydroxychloroquine with prednisolone FIN-RACo, or treatment with a single DMARD initially, sulfasalazine with or without prednisolone SINGLE. After 2 years, the drug-treatment strategy became unrestricted, but still targeted remission. The radiographs of hands and feet were analyzed by using the Larsen score at baseline, 2, 5, and 11 years, and the radiographs of large joints, at 11 years.

ResultsSixty-five patients in the FIN-RACo and 65 in the SINGLE group had radiographs of hands and feet available at baseline and at 11 years. The mean change from baseline to 11 years in Larsen score was 17 95% CI, 12 to 26 in the FIN-RACo group and 27 95% CI, 22 to 33 in the SINGLE group P = 0.037. In total, 87% 95% CI, 74 to 94 and 72% 95% CI, 58 to 84 of the patients in the FIN-RACo and the SINGLE treatment arms, respectively, had no erosive changes in large joints at 11 years.

ConclusionsTargeting to remission with tight clinical controls results in low radiologic progression in most RA patients. Patients treated initially with a combination of DMARDs have less long-term radiologic damage than do those treated initially with DMARD monotherapy.

Trial registrationCurrent Controlled Trials ISRCTN18445519.

AbbreviationsCIconfidence interval

DMARDdisease-modifying antirheumatic drug

FIN-RACostudy group treated for the first 2 years with a combination of three disease-modifying antirheumatic drugs: initially methotrexate: sulfasalazine: and hydroxychloroquine: with prednisolone

HAQhealth assessment questionnaire

IQRinterquartile range

RArheumatoid arthritis

RRrisk ratio

SDstandard deviation

SINGLEstudy group treated for the first 2 years with one disease-modifying antirheumatic drug: initially sulfasalazine: with or without prednisolone

TNFtumor necrosis factor.

Electronic supplementary materialThe online version of this article doi:10.1186-ar3060 contains supplementary material, which is available to authorized users.

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Autor: Vappu Rantalaiho - Markku Korpela - Leena Laasonen - Hannu Kautiainen - Salme Järvenpää - Pekka Hannonen - Marjatta Leir

Fuente: https://link.springer.com/







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