June 27, 2010 Disease-modifying antirheumatic drugs (DMARDs) should be used early and aggressively at the first sign of rheumatoid arthritis (RA). The results of an 11-year trial, published in BioMed Central's open access journal Arthritis Research & Therapy, demonstrate that active treatment from the very beginning pays off, even in the long run.
Dr Vappu Rantalaiho, from Tampere University Hospital, Finland, worked with a team of researchers to study radiologic progression in 195 patients with RA. She said, "Early therapy with combinations of conventional DMARDs has been shown to retard the radiologic progression of RA for a period of up to 5 years, but until now the effects of initial aggressive DMARD therapy on radiologic prognosis after that were unknown. We've shown that even after 11 years, early and aggressive therapy achieves excellent results for most patients."
For this study, 97 patients were initially randomized to receive a combination of DMARDs (starting with methotrexate, sulfasalazine, and hydroxychloroquine with prednisolone; FIN-RACo strategy) and 98 received a single DMARD (initially sulfasalazine with or without prednisolone; SINGLE strategy). After 2 years, the treatment of RA was unrestricted for both groups. Patients treated initially with the FIN-RACo strategy were found to have less radiographic damage in small joints, even in the long term, than those treated initially with DMARD monotherapy.
According to Rantalaiho, "Probably the most important precondition to our excellent results in most patients was the active treatment policy aiming at remission at all time points. Our results emphasize the importance of early remission for long term outcome. In the present study, the patients who were in strict remission at 1 year had significantly less radiologic progression throughout the follow-up than the patients who were not."
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- Vappu Rantalaiho, Markku Korpela, Leena Laasonen, Hannu Kautiainen, Salme Järvenpää, Pekka Hannonen, Marjatta Leirisalo-Repo, Harri Blåfield, Kari Puolakka, Anna Karjalainen, Timo Möttönen and the FIN-RACo Trial Group. 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. Arthritis Research & Therapy, 2010; (in press) [link]
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