Retardation of joint damage in patients with early RA by aggressive treatment with DMARDs

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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.

Tampere University Hospital, Tampere, Finland.

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

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