RESEARCH - Patient-reported outcomes comparing four different treatment strategies in recent-onset RA

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Arthritis Rheum. 2008 Dec 30;61(1):4-12. [Epub ahead of print]

Patient-reported outcomes in a randomized trial comparing four

different treatment strategies in recent-onset rheumatoid arthritis

van der Kooij SM, de Vries-Bouwstra JK, Goekoop-Ruiterman YP, Ewals

JA, Han KH, Hazes JM, Kerstens PJ, Peeters AJ, van Zeben D, Breedveld

FC, Huizinga TW, Dijkmans BA, Allaart CF.

Leiden University Medical Center, Leiden, The Netherlands.

OBJECTIVE: To investigate the effectiveness of 4 different treatment

strategies for recent-onset rheumatoid arthritis (RA) on 2-year

patient-reported outcomes, including functioning and quality of life.

METHODS: A total of 508 patients with recent-onset RA were randomly

assigned to 1) sequential monotherapy, 2) step-up combination therapy,

both starting with methotrexate, 3) initial combination therapy,

including a tapered high-dose prednisone, or 4) initial combination

therapy with methotrexate and infliximab. Treatment was adjusted every

3 months if the Disease Activity Score (DAS) remained >2.4. The

McMaster Toronto Arthritis Patient Preference Disability

Questionnaire, the Short Form 36 (SF-36), and scores for pain, global

health, and disease activity measured on a 100-mm visual analog scale

(VAS) were compared between groups at baseline and every 3 months

thereafter for 2 years.

RESULTS: After 2 years, all patient-reported outcomes had improved

significantly from baseline, irrespective of the treatment strategy.

SF-36 subscale scores approached population norms for 3 physical

components, and achieved population norms (P > 0.05) for bodily pain

and 4 mental components. Improvement in functioning, VAS scores, and

physical items of the SF-36 occurred significantly earlier in patients

treated with initial combination therapies (all comparisons after 3

months: overall P < 0.001; P < 0.05 for groups 1 and 2 versus groups 3

and 4).

CONCLUSION: All 4 DAS-driven treatment strategies resulted in

substantial improvements in functional ability, quality of life, and

self-assessed VAS scores after 2 years. Initial combination therapy

led to significantly faster improvement in all patient-reported

measures.

PMID: 19116965

http://www.ncbi.nlm.nih.gov/pubmed/19116965

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