RESEARCH - Long-term impact of early treatment on readiographic progression in RA: a meta-analysis

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Arthritis Rheum. 2006 Nov 30;55(6):864-872 [Epub ahead of print]

Long-term impact of early treatment on radiographic progression in

rheumatoid arthritis: A meta-analysis.

Finckh A, Liang MH, van Herckenrode CM, de Pablo P.

Brigham and Women's Hospital, Boston, Massachusetts.

OBJECTIVE: Although early initiation of disease-modifying antirheumatic

drugs (DMARDs) is effective in controlling short-term joint damage in

individuals with rheumatoid arthritis (RA), the long-term benefit in disease

progression is still controversial. We examined the long-term benefit of

early DMARD initiation on radiographic progression in early RA. METHODS: We

identified published and unpublished clinical trials and observational

studies from 1966 to September 2004 examining the association between delay

to treatment initiation and progressive radiographic joint damage. We

included studies of persons with RA disease duration <2 years and DMARD

therapy of similar efficacy during followup. The differences in annual rates

of radiographic progression between early and delayed therapy were pooled as

standardized mean differences (SMDs). RESULTS: A total of 12 studies met the

inclusion criteria. The pooled estimate of effects from these studies

demonstrated a significant reduction of radiographic progression in patients

treated early (-0.19 SMD, 95% confidence interval [95% CI] -0.34, -0.04),

which corresponded to a -33% reduction (95% CI -50, -16) in long-term

progression rates compared with patients treated later. Patients with more

aggressive disease seemed to benefit most from early DMARD initiation (P =

0.04).

CONCLUSION: These results support the existence of a critical period to

initiate antirheumatic therapy, a therapeutic window of opportunity early in

the course of RA associated with sustained benefit in radiographic

progression for up to 5 years. Prompt initiation of antirheumatic therapy in

persons with RA may alter the long-term course of the disease.

PMID: 17139662

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

7139662

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