DAS-driven therapy versus routine care in patients with recent-onset active rheumatoid arthritis

Goekoop-Ruiterman, Y.P.M.; Vries-Bouwstra, J.K. de; Kerstens, P.J.S.M.; Nielen, M.M.J.; Vos, K.; Schaardenburg, D. van; ... ; Dijkmans, B.A.C. (2010)

Article / Letter to editor

Objectives: To compare the efficacy of Disease Activity Score (DAS)-driven therapy and routine care in patients with recent-onset rheumatoid arthritis. Methods: Patients with recent-onset rheumatoid arthritis receiving traditional antirheumatic therapy from either the BeSt study, a randomised controlled trial comparing different treatment strategies (group A), or two Early Arthritis Clinics (group B) were included. In group A, systematic DAS-driven treatment adjustments aimed to achieve low disease activity (DAS <= 2.4). In group B, treatment was left to the discretion of the treating doctor. Functional ability (Health Assessment Questionnaire (HAQ)), Disease Activity Score in 28 joints (DAS28) and Sharp/van der Heijde radiographic score (SHS) were evaluated. Results: At baseline, patients in group A (n=234) and group B (n=201) had comparable demographic characteristics and a mean HAQ of 1.4. Group A had a longer median disease duration than group B (0.5 vs 0.4 years, p=0.016), a higher mean DAS28 (6.1 vs 5.7, p<0.001), more rheumatoid factor-positive patients (66% vs 42%, p<0.001) and more patients with erosions (71% vs 53%, p<0.001). After 1 year, the HAQ improvement was 0.7 vs 0.5 (p=0.029), and the percentage in remission (DAS28<2.6) 31% vs 18% (p<0.005) in groups A and B, respectively. In group A, the median SHS progression was 2.0 (expected progression 7.0), in group B, the SHS progression was 1.0 (expected progression 4.4). Conclusions: In patients with recent-onset rheumatoid arthritis receiving traditional treatment, systematic DAS-driven therapy results in significantly better clinical improvement and possibly improves the suppression of joint damage progression.

• modifying antirheumatic drug randomized controlled-trial placebo-controlled trial low-dose prednisolone combination therapy double-blind radiographic progression clinical-trial joint damage methotrexate

• All authors: Goekoop-Ruiterman, Y.P.M.; Vries-Bouwstra, J.K. de; Kerstens, P.J.S.M.; Nielen, M.M.J.; Vos, K.; Schaardenburg, D. van; Speyer, I.; Seys, P.E.H.; Breedveld, F.C.; Allaart, C.F.; Dijkmans, B.A.C.
• Date: 2010-01-31
• Journal: Annals of the Rheumatic Diseases
• Volume: 69
• Issue: 1
• Pages: 65 - 69
• DOI: doi:10.1136/ard.2008.097683