Retardation of joint damage in patients with early rheumatoid arthritis by initial aggressive treatment with disease-modifying antirheumatic drugs: Five-year experience from the FIN-RACo study

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Arthritis Rheum. 2004 Jul;50(7):2072-81.

Retardation of joint damage in patients with early rheumatoid arthritis

by initial aggressive treatment with disease-modifying antirheumatic drugs:

five-year experience from the FIN-RACo study.

Korpela M, Laasonen L, Hannonen P, Kautiainen H, Leirisalo-Repo M,

Hakala M, Paimela L, Blafield H, Puolakka K, Mottonen T; FIN-RACo Trial

Group.

Tampere University Hospital, Tampere, Finland. markku.korpela@...

OBJECTIVE: To evaluate the long-term frequency of disease remissions and

the progression of joint damage in patients with early rheumatoid arthritis

(RA) who were initially randomized to 2 years of treatment with either a

combination of 3 disease-modifying antirheumatic drugs (DMARDs) or a single

DMARD. METHODS: In this multicenter prospective followup study, a cohort of

195 patients with early, clinically active RA was randomly assigned to

treatment with a combination of methotrexate, sulfasalazine,

hydroxychloroquine, and prednisolone or with a single DMARD (initially,

sulfasalazine) with or without prednisolone. After 2 years, the DMARD and

prednisolone treatments became unrestricted, but were still targeted toward

remission. The long-term effectiveness was assessed by recording the

frequency of remissions and the extent of joint damage seen on radiographs

of the hands and feet obtained annually up to 5 years. Radiographs were

assessed by the Larsen score. RESULTS: A total of 160 patients (78 in the

combination group and 82 in the single group) completed the 5-year extension

study. At 2 years, 40% of the patients in the combination-DMARD group and

18% in the single-DMARD group had achieved remission (P < 0.009). At 5

years, the corresponding percentages were 28% and 22% (P not significant).

The median Larsen radiologic damage scores at baseline, 2 years, and 5 years

in the combination-DMARD and single-DMARD groups were 0 and 2 (P = 0.50), 4

and 12 (P = 0.005), and 11 and 24 (P = 0.001), respectively. CONCLUSION:

Aggressive initial treatment of early RA with the combination of 3 DMARDs

for the first 2 years limits the peripheral joint damage for at least 5

years. Our results confirm the earlier concept that triple therapy with

combinations of DMARDs contributes to an improved long-term radiologic

outcome in patients with early and clinically active RA.

PMID: 15248204 [PubMed - in process]