Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis

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Benefit of very early referral and very early therapy with disease-modifying

anti-rheumatic drugs in patients with early rheumatoid arthritis

V. P. K. Nell1, K. P. Machold1, G. Eberl2, T. A. Stamm1, M. Uffmann3 and J.

S. Smolen1,2

1 Department of Rheumatology, Vienna General Hospital, University of Vienna,

2 Department of Rheumatology, Lainz Hospital, Vienna, 3 Department of

Radiology, Vienna General Hospital, University of Vienna, Austria.

Correspondence to: J. S. Smolen, Department of Rheumatology, Internal

Medicine III, University of Vienna, Waehringer Guertel 18­20, A-1090 Vienna,

Austria. E-mail: f.Smolen@...

Objective. Delay of disease-modifying anti-rheumatic drug (DMARD) therapy is

a major contributing factor for poor outcome in rheumatoid arthritis (RA).

Although early therapy has been shown to be particularly effective, there is

still uncertainty about the optimal time point of DMARD introduction. We

wanted to test if a therapeutic window of opportunity may exist within the

first few months of the disease.

Methods. In this case-control parallel-group study, 20 very early RA (VERA)

patients with median disease duration of 3 months were age and gender

matched to a group of 20 late early RA (LERA) patients with median disease

duration of 12 months until first DMARD initiation. Follow-up time was 36

months. Primary outcome measures were the disease activity score (DAS28) and

radiological joint destruction using the Larsen method.

Results. Already after 3 months of DMARD therapy we found a significant

difference of improvement in favour of the VERA patients in the DAS28. This

trend continued over the study period. At study end the DAS28 showed an

improvement of 2.8±1.5 in the VERA vs 1.7±1.2 in the LERA group (Pc<0.05).

The Larsen scores showed a statistically significant retardation of

progression in the VERA compared with the LERA.

Conclusion. Our results indicate that there is a window of opportunity for

highly successful treatment of RA in the first year, and especially within

the first 3 months of therapy. Thus, early diagnosis and therapy may be the

crucial step in achieving optimal control of disease progression and

prognosis in RA.