June 16, 2008 At least 50% of recent onset rheumatoid arthritis patients achieve remission (a state free of signs and symptoms) within 36 weeks when following a systematic approach of step-up DMARD treatment in combination with tight control, according to results of a study presented June 11 at EULAR 2008, the Annual Congress of the European League Against Rheumatism in Paris, France. Results of this study indicate that achieving remission is not only possible during clinical trials but can be a realistic goal of standard clinical care.
Of 169 early RA patients, remission (defined as DAS28<2.6) was achieved in 15.5% at week 8 (23/148), 22.2% at week 12 (24/108), 30.7% at week 20 (23/75), 38.8% at week 24 (33/85), 52.1% at week 36 (38/73) and 51% at week 48-52 (26/51).
The researchers achieved these results through implementation of a tightly regulated DMARD treatment scheme, as follows:
- Methotrexate 15mg/week was initiated following diagnosis
- If remission was not achieved at week 8, the dose was increased to 25mg/week
- If not achieved at week 12, sulfasalazine was added (2grams/day)
- If not achieved at week 20, the dose was increased to 3grams/day
- If not achieved at week 24 adalimumab was added to methotrexate
Every 3 months thereafter, therapy could be adjusted based on DAS28, also using other TNF-blockers. Patients were allowed to take NSAIDs, and prednisolone d10mg/day and intra-articular corticosteroid injections could be administered
Dr. H. Kuper and Prof M. van de Laar of Medisch Spectrum Twente & University Twente, the Netherlands, who led the study, said; "In many large clinical trials, remission can be considered a realistic goal. We set out to determine whether all patients presenting in daily clinical practice can reasonably expect to achieve a state free of signs and symptoms, if a strict treatment schedule was followed. Our results show that remission is indeed achievable in as many as half of clinical practice patients following this schedule, which could indicate that remission is a realistic treatment goal of daily clinical practice."
As part of the Dutch Rheumatoid Arthritis Monitoring Registry (DREAM), investigators performed a prospective descriptive study of a cohort of recent onset rheumatoid arthritis DMARD-naïve, patients in daily clinical practice, between January 2006 and January 2008. 190 consecutive patients with recently diagnosed RA under the care of the rheumatology clinics of three hospitals in the Netherlands were included. Results were taken from the first 169 patients with DAS28>3.2 at inclusion.
At baseline, patient characteristics between the hospitals were comparable -- average patient age was 57.3 years (13.7), 63.9% were female, 52.7% of which were rheumatoid factor positive, with an average disease duration of 16 weeks (1-52), ESR 33.2 (20.5), CRP 23.5 (26.4), DAS28 5.1 (1.1), HAQ 1.3 (0.6).
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