RESEARCH - DAS-driven therapy versus routine care in patients with recent-onset active RA

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Ann Rheum Dis. Published Online First: 20 January 2009.

doi:10.1136/ard.2008.097683

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Extended Report

DAS-driven therapy versus routine care in patients with recent-onset

active Rheumatoid Arthritis

P M Goekoop-Ruiterman 1*, Jeska K de Vries-Bouwstra 2, Pit J S

M Kerstens 3, Markus M J Nielen 3, Koen Vos 3, Dirkjan van

Schaardenburg 3, Irene Speyer 4, E H Seys 5, Ferdinand C

Breedveld 1, Cornelia F Allaart 1 and Ben A C Dijkmans 2

1 Leiden University Medical Center, Netherlands

2 VU Medical Center, Netherlands

3 Jan van Breemen Institute, Netherlands

4 Hospital Bronovo, Netherlands

5 Hospital Lievensberg, Netherlands

Abstract

Objectives: To compare the efficacy of disease activity score

(DAS)-driven therapy and routine care in patients with recent-onset

rheumatoid arthritis.

Methods: Patients with recent-onset rheumatoid arthritis receiving

traditional antirheumatic therapy from either the BeSt study[1], a

randomized controlled trial comparing different treatment strategies

(group A) or 2 Early Arthritis Clinics (group were included. In

group A, systematic DAS-driven treatment adjustments aimed to achieve

low disease activity (DAS 2.4). In group B, treatment was left to the

discretion of the treating physician. We evaluated functional ability

(HAQ), disease activity score in 28 joints (DAS28) and Sharp/van der

Heijde radiographic score (SHS).

Results: At baseline, patients in group A (n=234) and group B (n=201)

had comparable demographic characteristics and a mean HAQ of 1.4.

Group A had a longer median disease duration than group B (0.5 vs 0.4

year, p=0.016), a higher mean DAS28 (6.1 vs 5.6, p<0.001), more

rheumatoid factor positive patients (66% vs 42%, p<0.001) and more

erosive patients (71% vs 53%, p<0.001). After 1 year, the HAQ

improvement was 0.7 vs 0.5 (p=0.029), and the percentage in remission

(DAS28<2.6) 31% vs 18% (p<0.005) in groups A and B, respectively. In

group A, the median SHS progression was 2.0 (expected progression

7.0), in group B, the SHS progression was 1.0 (expected progression

4.4).

Conclusions: In patients with recent onset rheumatoid arthritis

receiving traditional therapy, systematic DAS-driven therapy results

in significantly better clinical improvement and possibly improves the

suppression of joint damage progression.

http://ard.bmj.com/cgi/content/abstract/ard.2008.097683v1?papetoc

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