Abstract
Background. In rheumatoid arthritis (RA), prompt diagnosis and initiation of disease-modifying treatment during the first months after disease onset – a period called “window of opportunity” – is significantly superior to the delayed start of the same therapy. Clinical remission is more frequently obtained in patients with a disease duration no longer than 4 months and is the main aim of the treatment, therefore the “treat to target” (T2T) and “tight control” strategies were proposed. Objective. The aim of this study is to evaluate the therapy used for patients with early RA (ERA) and the impact of this medication on the clinical outcomes at 12 months after the first evaluation. Methods. Patients with early arthritis who were referred to the Early Arthritis Research Center of Dr. I. Cantacuzino Hospital between 2010-2014 and who fulfilled the 2010 EULAR/ACR Classification Criteria for RA (and who did not satisfy classification criteria for other inflammatory rheumatologic diseases) were enrolled. Only patients who received treatment with Methotrexate (MTX) associated or not with corticosteroids (CS) and patients who fulfilled the classification criteria for RA but did not received any DMARDs therapy were enrolled. Results. Forty-three patients were enrolled in the study, 62.8% females, mean age 55.47±13.71 years, median (interquartile range) DAS28 5.07 (4.31-5.60), SDAI 29.02 (20.92-34.61). At the first presentation, 40 patients (93.0%) received treatment with Methotrexate (MTX) in doses ranging from 5 mg/week to 20 mg/week, with a mean dose of 11.16±4.47 mg/week, the most frequently used doses ranging from 10 mg/week to 15 mg/week. 26 patients (60.5%) received corticosteroids (CS), either oral or intra-articular. During the study both the total number of patients receiving MTX and the mean dose of MTX increased, while the number of patients receiving CS decreased and at the end of the study only low-dose oral CS were still administered in 8 patients. At 12 months, median (interquartile range) DAS 28 was 1.77 (1.43-3.16), SDAI 3.58 (2.32-11.82). The evolution under treatment assessed by DAS28 and SDAI wasn’t significantly different between patients who received, at baseline, MTX in association with CS (mean value: ΔDAS28=-2.58±1.72, ΔSDAI=-20.44±16.49) and those who received MTX monotherapy (mean value: ΔDAS28=-2.91±1.17, ΔSDAI=-21.80±9.89) (p>0.05). There was no significant difference in change from baseline of DAS28 and SDAI at 12 months between patients who received low-dose oral CS and those who received intermittent intra-articular CS (p>0.05). Conclusions. Treatment with MTX and/or CS led to clinical and laboratory improved outcomes at 12 months of follow-up. There was no significant difference regarding long-term outcomes between patients who received low dose oral CS and those who received intra-articular CS. As this study was performed on a relatively small number of real-life patients with ERA, the results obtained should be validated on larger cohorts of patients.
Highlights
In rheumatoid arthritis (RA), prompt diagnosis and initiation of disease-modifying treatment during the first months after disease onset – a period called “window of opportunity” – is significantly superior to the delayed start of the same therapy
In this study we followed up a cohort of patients with early RA (ERA) attending our Early Inflammatory Arthritis (EIA) research center between 2010-2014, in whom treatment was decided by the attending rheumatologist without having to respect a strict algorithm
The cohort had a remarkably short disease duration at baseline: despite the small number of patients, the median duration of symptoms at the first presentation was shorter than that reported in the Leiden EIA cohort (18.7 weeks) and than that reported in the ESPOIR cohort
Summary
In rheumatoid arthritis (RA), prompt diagnosis and initiation of disease-modifying treatment during the first months after disease onset – a period called “window of opportunity” – is significantly superior to the delayed start of the same therapy. Patients who received treatment with Methotrexate (MTX) associated or not with corticosteroids (CS) and patients who fulfilled the classification criteria for RA but did not received any DMARDs therapy were enrolled. There was no significant difference in change from baseline of DAS28 and SDAI at 12 months between patients who received low-dose oral CS and those who received intermittent intra-articular CS (p>0.05). In 2013, Smolen et al published the EULAR recommendations for the management of RA They stated that disease-modifying anti-rheumatic drug (DMARD) therapy should be started as soon as the ROMANIAN JOURNAL OF RHEUMATOLOGY – VOLUME XXV, NO. For ERA patients, MTX monotherapy is considered the first option, while corticosteroids (CS) are recommended only if disease flares, for short periods of time and at the lowest effective dose. For ERA patients, MTX monotherapy is considered the first option, while corticosteroids (CS) are recommended only if disease flares, for short periods of time and at the lowest effective dose. [4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
