Better Outcome for Rheumatoid Arthritis Patients

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Better Outcome for Rheumatoid Arthritis Patients

Results of a UK study suggest that intensive monthly outpatient treatment

with antirheumatic drugs and steroid injections can substantially improve

patients¹ symptoms of rheumatoid arthritis compared with standard

three-month outpatient treatment.

ISSUE: JULY 17 2004

Lancet 2004; 364: 263-69

Newswise ‹ Results of a UK study in this week¹s issue of THE LANCET suggest

that intensive monthly outpatient treatment with antirheumatic drugs and

steroid injections can substantially improve patients¹ symptoms of

rheumatoid arthritis compared with standard three-month outpatient

treatment.

Duncan Porter (Gartnavel General Hospital, Glasgow, UK) and colleagues

investigated whether a more intensive approach‹monthly assessment of

patients¹ disease activity score (DAS) to guide treatment with oral

antirheumatic drugs and steroid injections‹could be more effective in

improving symptoms than standard three-monthly assessment without a DAS

calculation to guide treatment.

The investigators randomized 111 people with rheumatoid arthritis to either

intensive management or routine care. The study¹s main outcome measure was

to compare the proportion of patients in each group achieving a good

response to treatment‹defined as a DAS below 2·4 and a fall in this score

from baseline by more than 1·2 points. Comparisons between patients in the

two groups were made after 18 months.

82% of patients given intensive therapy achieved a good response to

treatment compared with 44% in the standard treatment group. Furthermore,

65% of patients in the intensive group were in remission at the end of the

study compared with only 16% of patients in the standard group. Intensive

treatment was no more costly than standard treatment.

Dr Porter comments: ³The results of this study have considerable

implications for the management of people with rheumatoid arthritis. Despite

initial concerns, cost did not differ between intensive management of

patients and routine treatment. Whether the improvement in patients¹

outcomes will translate into longer-term savings, such as a reduction in

work disability, the need for jointreplacement surgery, or the need for

institutional care, remains to be seen. More importantly, our results show

that a strategy of optimising current techniques and treatment regimens can

deliver substantial patients¹ benefits within a costneutral framework.²

Please remember to cite The Lancet.