RESEARCH - Treatment with DMARDs immediately after diagnosis results in less joint surgery in RA

[Guest guest]

ls of the Rheumatic Diseases 2006;65:1506-1511

© 2006 by BMJ Publishing Group Ltd & European League Against Rheumatism

--------------------------------------------------------------------------

EXTENDED REPORT

Joint surgery in the Utrecht Rheumatoid Arthritis Cohort: the effect of

treatment strategy

S M M Verstappen1, J N Hoes1, E J ter Borg2, J W J Bijlsma1, A A M Blaauw3,

G A van Albada-Kuipers4, C van Booma-fort5, J W G s1 on behalf of

the Utrecht Rheumatoid Arthritis Cohort study group

1 University Medical Center Utrecht, Utrecht, The Netherlands

2 Antonius Hospital, Nieuwegein, The Netherlands

3 Flevo Hospital, Almere, The Netherlands

4 Meander Medical Center, Amersfoort, The Netherlands

5 Diakonessenhuis, Utrecht

Objective: To investigate the prevalence and prognostic factors of joint

surgery in a large cohort of patients with rheumatoid arthritis, whose

treatment, clinical and radiographic data have been assessed at predefined

points in time since disease onset.

Methods: Data on surgical interventions were retrospectively obtained from

482 patients with rheumatoid arthritis whose follow-up data for at least 2

years were available, including treatment and response to treatment during

the first 2 years. Survival time until the first surgical intervention and

until the first major surgical intervention was determined for the total

study population by Kaplan-Meier survival curves. Three separate

regression analyses were carried out to determine which variables measured

at baseline, during the first year and during the first 2 years were

predictors for joint surgery.

Results: 27% of the patients underwent surgical interventions. Mean survival

time until the first surgical intervention was 10.4 years. The percentage of

patients with a surgical intervention was 10% lower in the group with

response to treatment when compared with the non-response group. Next to a

delayed start with disease-modifying antirheumatic drugs, fast radiographic

progression during the first year and first 2 years was a predictor of joint

surgery in the multivariate regression analyses.

Conclusion: Treatment with disease-modifying antirheumatic drugs immediately

after diagnosis results in less joint surgery when compared with a delayed

start. Furthermore, joint surgery is carried out more often in patients who

do not respond to treatment.

http://ard.bmjjournals.com/cgi/content/abstract/65/11/1506?etoc

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org