Impact of initial aggressive drug treatment with a combination of DMARDs on the development of work disability in early RA

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Arthritis Rheum. 2004 Jan; 50(1): 55-62.

Impact of initial aggressive drug treatment with a combination of

disease-modifying antirheumatic drugs on the development of work

disability in early rheumatoid arthritis: a five-year randomized

followup trial.

Puolakka K, Kautiainen H, Mottonen T, Hannonen P, Korpela M, Julkunen H,

Luukkainen R, Vuori K, Paimela L, Blafield H, Hakala M, Leirisalo-Repo

M.

Lappeenranta Central Hospital, Lappeenranta, Finland.

kari.puolakka@...

OBJECTIVE: To compare the efficacy of therapy with a combination of

disease-modifying antirheumatic drugs (DMARDs) versus therapy with a

single DMARD in the prevention of work disability in patients with early

rheumatoid arthritis (RA). METHODS: In the Finnish Rheumatoid Arthritis

Combination Therapy trial, 195 patients with recent-onset RA were

randomly assigned to receive either combination therapy with DMARDs

(sulfasalazine, methotrexate, hydroxychloroquine) plus prednisolone or

single therapy with a DMARD with or without prednisolone. After 2 years,

the drug treatment strategy was no longer restricted. At baseline, 162

patients (80 in the combination-treatment group and 82 in the

single-treatment group) were still working or at least available for

work. After 5 years of followup, data on all sick leave and retirement

were obtained from social insurance registers or case records. The main

outcome for each patient was the cumulative duration of all sick leaves

and RA-related disability pensions, divided by the observation period

during which the patient was not retired because of another disease or

because of age. RESULTS: The cumulative duration of work disability per

patient-observation year was significantly lower in those randomized to

combination therapy than in those randomized to single therapy: median

12.4 days (interquartile range [iQR] 0-54) versus 32.2 days (IQR 6-293)

(P = 0.008, sex- and age-adjusted P = 0.009). This was mainly due to the

difference in sick leaves (i.e., work disability periods </=300 days):

median 11.7 days (IQR 0-44) per patient-observation year in those

treated with combination therapy and 30.0 days (IQR 6-68) in those

treated with single therapy (P = 0.002). No statistically significant

difference was seen in RA-related disability pensions.

CONCLUSION: Aggressive initial treatment of RA with a combination of

DMARDs improves 5-year outcome in terms of lost productivity in patients

with RA of recent onset.

PMID: 14730599

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