RESEARCH - Early treatment with and time on first DMARD predicts long-term function in patients with inflammatory polyarthritis

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Ann Rheum Dis. Published Online First: 26 October 2009.

doi:10.1136/ard.2009.108639

Early treatment with and time on first Disease Modifying

Anti-Rheumatic Drug predicts long-term function in patients with

inflammatory polyarthritis

Tracey M Farragher1, Mark Lunt1, Bo Fu1, Diane Bunn2, Deborah Symmons1,*

1 University of Manchester, United Kingdom;

2 Norfolk and Norwich University Hospital, United Kingdom

ABSTRACT

Objectives: To investigate the influence of early disease modifying

anti-rheumatic drug (DMARD) treatment on long-term functional outcome

in patients with recent onset inflammatory polyarthritis (IP), and the

impact of the duration of first and subsequent DMARD treatment.

Methods: 642 subjects from a primary-care registry of patients with

new onset IP, recruited 1990-1994, were followed for 10 years. Mean

change in HAQ scores between baseline and 10 years were compared by

time to and time on first DMARD treatment and total time on treatment,

using linear regression. Adjustment for time dependent confounders and

censoring was performed using marginal structural weights.

Results: When adjusted for baseline and subsequent disease severity,

those treated early (<6 months from symptom onset) experienced a

non-significant improvement in function compared to those never

treated (adjusted mean difference in change (adj_MDIC) in HAQ -0.24;

95% CI -0.58, 0.09); and a significant benefit for each additional

month of treatment within 6 months of the onset of symptoms (adj_MDIC

-0.10 95% CI; -0.19, -0.02). Patients who discontinued their first

DMARD within 6 months experienced a significant deterioration in

long-term function (adj_MDIC in HAQ 0.28 95% CI; 0.04, 0.52), while

those who continued their first therapy for greater than 3 years

experienced an improvement (adj_MDIC in HAQ -0.37; 95% CI -0.77,

0.04).

Conclusions: We have demonstrated the importance of time to and

response to first DMARD treatment and total duration of DMARD

treatment in modifying the 10 year function in patients with IP.

http://ard.bmj.com/cgi/content/abstract/ard.2009.108639v1?papetoc

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