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.
Highlights
Treatment of rheumatoid arthritis (RA) has been shown to retard the development of joint damage for a period of up to 5 years
We previously demonstrated that early RA patients treated with a combination of disease-modifying antirheumatic drug (DMARD) reached, at 2 years, more often clinical remission [3] and had less radiographic progression at 2 years [3] and at 5 years [10] than did patients initially treated with a single DMARD
At the 11-year visit, 68 patients were assessed in the FIN-RACo group, and 70, in the SINGLE group; the patients' baseline demographic and clinical characteristics were comparable [11]
Summary
Treatment of rheumatoid arthritis (RA) has been shown to retard the development of joint damage for a period of up to 5 years. Treated cohorts of rheumatoid arthritis (RA) patients have shown a constant deterioration of the radiologic progression of RA for a period of up to 5 years [4,10], but the effects of initial aggressive DMARD therapy on radiologic prognosis after that are unknown. At 11 years, most patients in both treatment groups had low disease activity and well-preserved function, but the combination DMARD-group patients reached remission more often than did those treated initially with a single DMARD [11]. We explored the effects of initial treatment strategy on the long-term radiographic findings at 11 years
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