RESEARCH - Early combination DMARD therapy and tight disease control improve long-term outcome in RA

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Arthritis Res Ther. 2010;12(3):R122. Epub 2010 Jun 24.

Early combination disease-modifying antirheumatic drug therapy and

tight disease control improve long-term radiologic outcome in patients

with early rheumatoid arthritis: the 11-year results of the Finnish

Rheumatoid Arthritis Combination Therapy trial.

Rantalaiho V, Korpela M, Laasonen L, Kautiainen H, Järvenpää S,

Hannonen P, Leirisalo-Repo M, Blåfield H, Puolakka K, Karjalainen A,

Möttönen T; the FIN-RACo Trial Group.

Department of Internal Medicine, Centre for Rheumatic Diseases,

Tampere University Hospital, PO Box 2000, FI-33521 Tampere, Finland.

ABSTRACT

INTRODUCTION : Early treatment of rheumatoid arthritis (RA) has been

shown to retard the development of joint damage for a period of up to

5 years. The aim of this study was to evaluate the radiologic

progression beyond that time in patients with early RA initially

treated with a combination of three disease-modifying antirheumatic

drugs (DMARDs) or a single DMARD.

METHODS : A cohort of 199 patients with early active RA were initially

randomized to receive treatment with a combination of methotrexate,

sulfasalazine, and hydroxychloroquine with prednisolone (FIN-RACo), or

treatment with a single DMARD (initially, sulfasalazine) with or

without prednisolone (SINGLE). After 2 years, the drug-treatment

strategy became unrestricted, but still targeted remission. The

radiographs of hands and feet were analyzed by using the Larsen score

at baseline, 2, 5, and 11 years, and the radiographs of large joints,

at 11 years.

RESULTS : Sixty-five patients in the FIN-RACo and 65 in the SINGLE

group had radiographs of hands and feet available at baseline and at

11 years. The mean change from baseline to 11 years in Larsen score

was 17 (95% CI, 12 to 26) in the FIN-RACo group and 27 (95% CI, 22 to

33) in the SINGLE group (P = 0.037). In total, 87% (95% CI, 74 to 94)

and 72% (95% CI, 58 to 84) of the patients in the FIN-RACo and the

SINGLE treatment arms, respectively, had no erosive changes in large

joints at 11 years.

CONCLUSIONS : Targeting to remission with tight clinical controls

results in low radiologic progression in most RA patients. Patients

treated initially with a combination of DMARDs have less long-term

radiologic damage than do those treated initially with DMARD

monotherapy.

TRIAL REGISTRATION : Current Controlled Trials ISRCTN18445519.

PMID: 20576092

http://www.ncbi.nlm.nih.gov/pubmed/20576092

Full article:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2911916

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