Two-year clinical and radiologic follow-up of early RA patients treated with initial step up monotherapy or initial step down therapy with glucocorticoids, followed by a tight control approach: lessons from a cohort study in daily practice

De Cock, Diederik; Vanderschueren, Geert; Meyfroidt, Sabrina; Joly, Johan; Westhovens, Rene; Verschueren, Patrick

doi:10.1007/s10067-013-2398-9

Two-year clinical and radiologic follow-up of early RA patients treated with initial step up monotherapy or initial step down therapy with glucocorticoids, followed by a tight control approach: lessons from a cohort study in daily practice

Author:

De Cock, Diederik

Vanderschueren, Geert ; Meyfroidt, Sabrina ; Joly, Johan ; Westhovens, Rene ; Verschueren, Patrick

Keywords:

Science & Technology, Life Sciences & Biomedicine, Rheumatology, Early RA, Epidemiology, Radiologic outcome, Rapid radiographic progress, Remission, Steroids, EARLY RHEUMATOID-ARTHRITIS, IMPORTANT DIFFERENCE, COMBINATION THERAPY, RANDOMIZED-TRIAL, JOINT DAMAGE, PROGRESSION, REMISSION, DRUG, Aged, Antirheumatic Agents, Arthritis, Rheumatoid, Cohort Studies, Disease Progression, Female, Follow-Up Studies, Foot, Glucocorticoids, Hand, Humans, Male, Middle Aged, Radiography, Remission Induction, Severity of Illness Index, Surveys and Questionnaires, Time Factors, Treatment Outcome, X-Rays, 1103 Clinical Sciences, Arthritis & Rheumatology, 3202 Clinical sciences, 3204 Immunology, 4201 Allied health and rehabilitation science

Abstract:

The objective of the study was to evaluate the effect of initial disease-modifying antirheumatic drug (DMARD) combination therapy with steroids (ICTS) and DMARD monotherapy (IMT) on the clinical and radiologic evolution of patients with early rheumatoid arthritis (RA) over a 2-year treatment period, applying tight control (TC) in daily practice. Seventy-four DMARD-naive early RA patients received ICTS or IMT in a TC setting. Baseline and year 1 and year 2 X-rays of hands and feet were scored according to Sharp/van der Heijde. Rapid radiographic progression (RRP) was defined as total Sharp score (TSS) of >5 units/year. At year 1, both treatment groups achieved 50 % remission. At year 2, 37 % of IMT and 60 % of ICTS patients were in remission, despite ICTS patients having initially a more severe RA profile. RRP was found in 4/74 patients at year 1: 3 IMT and 1 ICTS patients. Remarkably, three of these four patients had no radiographic progression in the second year. Five other patients had RRP in the second year: four IMT and one ICTS patients. In a TC setting, ICTS and IMT can prevent radiographic progression in the majority of patients in the daily practice of a Belgian academic hospital over 2 years. ICTS seems to be more effective than IMT in achieving higher remission rates and less radiographic progression.