RESEARCH - Early clinical response predicts 5-year outcome in RA: CAMERA

[Guest guest]

Ann Rheum Dis doi:10.1136/ard.2010.137943

Clinical and epidemiological research

Concise report

Early clinical response to treatment predicts 5-year outcome in RA

patients: follow-up results from the CAMERA study

M F Bakker1, J W G s1, P M J Welsing1,2, S A Vreugdenhil3, C van

Booma-fort4, S P Linn-Rasker5, E Ton1, F P J G Lafeber1, J W J

Bijlsma1, ; on behalf of the Utrecht Arthritis Cohort Study Group

1Department of Rheumatology & Clinical Immunology, University Medical

Center Utrecht, Utrecht, The Netherlands

2Julius Center for Health Sciences and Primary Care, University

Medical Center Utrecht, Utrecht, The Netherlands

3Department of Rheumatology, St Antonius Hospital, Nieuwegein, The Netherlands

4Department of Rheumatology, Diakonessenhuis, Utrecht, The Netherlands

5Department of Rheumatology, Meander Medical Center, Amersfoort, The Netherlands

Abstract

Objective To investigate the long-term effects of the tight control

(TC) and conventional (CT) methotrexate-based strategies of the

Computer Assisted Management in Early Rheumatoid Arthritis trial in

early rheumatoid arthritis and evaluate the predictive value of an

early response to treatment.

Methods Clinical and radiographic 5-year outcome was compared between

initial strategies. Patients were classified according to the EULAR

response criteria. The prognostic value of early response to treatment

in addition to established predictors was analysed by multiple linear

regression analyses.

Results 5 years of data were available for 205 of 299 patients, with

no indication for selective drop-out. At 5 years there was no longer

any significant difference for clinical and radiographic outcomes

between treatment strategies applied during the first 2 years.

Good-responders had a mean disease activity score of 2.39 (1.2) and

median yearly radiographic progression rate of 0.6 (0.0 to 2.2) at 5

years; significantly lower (both p<0.02) when compared to moderate-

and non-responders. Multiple regression analysis showed that early

response to treatment is an independent predictor of 5-year outcome,

irrespective of treatment strategy.

Conclusions The difference in disease activity between treatment

strategies disappeared over the years. Good-response to treatment

independently predicts significantly better 5-year clinical and

radiographic outcome. The TC principle probably should be continued in

the long-term.

http://ard.bmj.com/content/early/2011/03/14/ard.2010.137943.abstract?papetoc

Not an MD