RESEARCH - The long-term benefits of early aggressive treatment for RA

[Guest guest]

American College of Rheumatology

Embargo Date: July 6, 2004 at 12:01 AM EST

Arthritis & Rheumatism News Alert

The Long-Term Benefits of Early Aggressive Treatment for Rheumatoid

Arthritis

Follow-Up Study Confirms Effectiveness of Combination Drug Therapy for

Sustaining Disease Remission

Rheumatoid Arthritis (RA) is a chronic, potentially crippling disease marked

by inflammation of the tissue lining the joints and gradual destruction of

cartilage and bone. To ease RA's painful symptoms and debilitating

progression, abundant evidence supports early treatment with

disease-modifying anti-rheumatic drugs (DMARDs). In the mid-1990s,

researchers in Finland conducted a study of two groups of patients in the

very early stages of RA to compare the benefits of a combination of DMARDs

against the conventional single-DMARD therapy. After two years, the group

treated with only one DMARD experienced an 18 percent remission rate,

slightly better than the 14 percent frequency for spontaneous remission. In

striking contrast, 40 percent of the early RA patients achieved remission in

the group treated with three different DMARDs simultaneously.

How long do RA patients benefit from early aggressive DMARD-therapy? In the

July 2004 issue of Arthritis & Rheumatism, the results of a follow-up study

offer important insights for managing the disease and slowing joint damage.

Led by Dr. Markku Korpela of Tampere University Hospital in Finland, the

researchers set out to assess the progression of RA in both patient groups

up to five years after their initial clinical trial. The extended study

focused on a total of 160 patients-78 who were treated early with a

combination of DMARDs; 82 who received single-DMARD therapy. The researchers

found notable differences between the two groups to support the long-term

benefits of early treatment of RA with triple DMARDs. What's more, patients

who adopted this aggressive course of drug therapy two or more years after

their initial diagnosis did not achieve the same levels of decline in

disease activity. The results of this study will be available online July 6,

2004 via Wiley InterScience

(http://www.interscience.wiley.com/journal/arthritis).

After completing the first two-year study, all participants were free to

change their treatment, under a doctor's care. 70 of the 78 in the

combination group continued to receive the three DMARDs. In contrast, 51 of

the 82 patients originally prescribed a solitary DMARD opted to increase to

a mix of DMARDs. At the five-year follow-up, the original combination group

had a higher rate of remission (28 percent) than the original single-DMARD

group (21 percent). Even though the majority of the single group had

switched to a combination, the level of remission remained remarkably

stable. Beyond reporting less swelling, pain, and loss of mobility, the

original combination group experienced, according to radiographs of the

hands and feet, significantly less joint damage from the onset of RA than

the single DMARD group.

" The results imply that the 'late' institution of DMARD combination does not

increase the rate of remission in patients who are initially treated with a

single DMARD at a time; that is, the therapeutic 'window of opportunity'

appears to be lost in most of these patients, " Dr. Korpela and colleagues

observed, noting that the development of joint erosions in RA was markedly

retarded by early institution of DMARD combination therapy, and the

beneficial effect was still maintained at five years in spite of liberation

of DMARD therapy after two years.

Dr. Korpela concludes by emphasizing the need for further research into the

long-term benefits of early and ongoing combination DMARD therapy, as well

as safety issues. He also calls for studies comparing the effects, and the

cost-effectiveness, of multiplying the power of traditional DMARDs against

the use of new, very expensive, and increasingly popular biologic

antirheumatic drugs.

# # #

Article: " 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, " Markku

Korpela, Leena Laasonen, Pekka Hannonen, Hannu Kautiainen, Marjatta

Leirisalo-Repo, Markku Hakala, Leena Paimela, Harri Blåfield, Kari Puolakka,

and Timo Möttönen, for the FIN-RACo Trial Group, Arthritis & Rheumatism,

July 2004; Published Online: July 6, 2004; pp. 2072-2081.

http://www.rheumatology.org/press/2004/longterm0704.asp?aud=prs

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