Good response to early DMARD treatment of RA patients in the first year predicts remission during follow-up

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Ann Rheum Dis. 2004 May 6 [Epub ahead of print]

A good response to early DMARD treatment of patients with rheumatoid

arthritis in the first year predicts remission during follow-up.

Verstappen SM, Van Albada-Kuipers GA, Bijlsma JW, Blaauw AA, Schenk Y,

Haanen HC, s JW.

University Medical Center Utrecht, The Netherlands.

OBJECTIVE: To describe the frequency and duration of remission in the

Utrecht Rheumatoid Arthritis Cohort of patients with rheumatoid

arthritis (RA) followed since diagnosis. To describe clinical and

treatment characteristics of patients with remission versus patients

without remission. METHODS: In 1990 the Utrecht Rheumatoid Arthritis

Cohort study group started a clinical trial in which patients with

recent onset of RA (< 1 year) were randomised into four treatment

strategy groups: 1) the Hydroxychloroquine group (n=169) 2) the

Intramuscular gold group (n=163), 3) the Methotrexate group (n=166), or

4) the pyramid group (n=64). After two years, Rheumatologists were

allowed to prescribe any DMARD. Remission was defined as: duration of

morning stiffness < 15 minutes, mean VAS pain < 10 mm, joint

score < 10, and ESR < 30 mm/hr1st during at least six months. To

determine baseline clinical, demographic, and treatment predictors of

remission a regression analysis was performed. RESULTS: Mean

follow-up duration was 62 months. Thirty-six percent achieved at least

one period of remission. Median duration between diagnosis and the first

remission period was 15 months for the intramuscular gold group, 18

months for both the methotrexate group and the hydroxychloroquine group,

and 24 months for the pyramid group (not significantly different).

Predictors of remission were early response to initial treatment, less

pain, rheumatoid factor negativity and lower joint score at baseline.

CONCLUSION: After a mean follow-up duration of 62 months, only 36% of

the patients had fulfilled the remission criteria at least once. A good

response to treatment during the first year seems to be independently

associated with remission rather than initial treatment alone.

PMID: 15130899

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