Radiological outcome after four years of early versus delayed treatment strategy in patients with recent onset rheumatoid arthritis

• Published in: Annals of the rheumatic diseases Vol. 63; no. 3; pp. 274 - 279
• Main Authors: van Aken, J, Lard, L R, le Cessie, S, Hazes, J M W, Breedveld, F C, Huizinga, T W J
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01-03-2004; BMJ; BMJ Publishing Group Ltd; BMJ Publishing Group LTD
• Subjects: ACR; Adult; Aged; American College of Rheumatology; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - diagnostic imaging; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - immunology; Biological and medical sciences; Chloroquine - therapeutic use; disease modifying antirheumatic drugs; Disease Progression; Diseases of the osteoarticular system; DMARDs; Drugs; EAC; early arthritis clinic; early rheumatoid arthritis; Epitopes - immunology; erythrocyte sedimentation rate; ESR; Extended Report; Female; follow up; Genetic Predisposition to Disease; HLA-DR Antigens - analysis; HLA-DRB1 Chains; Humans; Hypotheses; Immunoglobulin M - blood; Inflammatory joint diseases; Male; Medical sciences; Middle Aged; non-steroidal anti-inflammatory drugs; NSAIDs; Radiography; Rheumatism; Rheumatoid arthritis; rheumatoid factor; Rheumatoid Factor - blood; Rheumatology; shared epitope; Studies; Sulfasalazine - therapeutic use; Time Factors; treatment; Treatment Outcome; Human; Immunopathology; Prognosis; Diseases of the osteoarticular system; Rheumatology; Autoimmune disease; Inflammatory joint disease; Delay; Chronic; Treatment; Rheumatoid arthritis; Evolution; Early; Strategy; Comparative study
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.2003.010298

Objective: To determine the effect of different treatment strategies (early versus delayed) on the radiological progression of joint damage during 4 years. Additionally, to determine the effect of treatment strategy on the association of HLA class II alleles and joint damage. Methods: Progression of radiographic damage and association of radiographic damage and genetic predisposition were compared in two cohorts, one treated according to the delayed treatment strategy (initial treatment with analgesics), the other treated according to the early treatment strategy (treatment with disease modifying antirheumatic drugs (DMARDs) chloroquine or sulfasalazine). Radiographic damage was measured by the modified Sharp-van der Heijde method. Genetic predisposition was determined by high resolution HLA-DR and DQ typing. Results: A completers-only analysis of 153 patients (originally 206 patients) in a non-randomised design showed less radiographic progression from 0 to 4 years in the early treatment group (median Sharp progression rate 1.3 points/year, n = 75) than in the delayed treatment group (2.5 points/year, n = 78) (p = 0.03). The progression from 1 to 4 years did not differ significantly between the groups. At 4 years, joint destruction in both groups was positively correlated with the presence of the shared epitope. Conclusions: The beneficial effect of early DMARD treatment on the radiological progression of joint damage is still present at 4 years. However, the rate of joint destruction from 1 to 4 years did not differ between the delayed and early treatment group. Neither the radiographic nor the immunogenetic data suggest that longlasting disease modification has been induced by early treatment.