RESEARCH - Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study)

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Lancet. 2004 Jul 17-23;364(9430):263-9.

Effect of a treatment strategy of tight control for rheumatoid arthritis

(the TICORA study): a single-blind randomised controlled trial.

Grigor C, Capell H, Stirling A, McMahon AD, Lock P, Vallance R, Kincaid W,

Porter D.

Gartnavel General Hospital, Glasgow G12 0YN, UK.

BACKGROUND: Present treatment strategies for rheumatoid arthritis include

use of disease-modifying antirheumatic drugs, but a minority of patients

achieve a good response. We aimed to test the hypothesis that an improved

outcome can be achieved by employing a strategy of intensive outpatient

management of patients with rheumatoid arthritis--for sustained, tight

control of disease activity--compared with routine outpatient care. METHODS:

We designed a single-blind, randomised controlled trial in two teaching

hospitals. We screened 183 patients for inclusion. 111 were randomly

allocated either intensive management or routine care. Primary outcome

measures were mean fall in disease activity score and proportion of patients

with a good response (defined as a disease activity score <2.4 and a fall in

this score from baseline by >1.2). Analysis was by intention-to-treat.

FINDINGS: One patient withdrew after randomisation and seven dropped out

during the study. Mean fall in disease activity score was greater in the

intensive group than in the routine group (-3.5 vs -1.9, difference 1.6 [95%

CI 1.1-2.1], p<0.0001). Compared with routine care, patients treated

intensively were more likely to have a good response (definition, 45/55

[82%] vs 24/55 [44%], odds ratio 5.8 [95% CI 2.4-13.9], p<0.0001) or be in

remission (disease activity score <1.6; 36/55 [65%] vs 9/55 [16%], 9.7

[3.9-23.9], p<0.0001). Three patients assigned routine care and one

allocated intensive management died during the study; none was judged

attributable to treatment.

INTERPRETATION: A strategy of intensive outpatient management of rheumatoid

arthritis substantially improves disease activity, radiographic disease

progression, physical function, and quality of life at no additional cost.

PMID: 15262104

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

5262104

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