Targeted treatment in early rheumatoid arthritis

Klarenbeek, N.B. (2013)

Doctoral Thesis

With the implementation of new treatment options, including biologicals and the early, agressive start of target-steered treatment the outlook for rheumatoid arthritis patients improved considerably the past decades. This thesis describes several aspects of modern rheumatoid arthritis treatment from the perspective of the BeSt study, a randomised controlled trial comparing four treatment strategies. The main findings from BeSt were that initial combination therapy, including high dose prednisone or the tumour necrosis factor inhibitor infliximab led to an earlier improvement in functional limitations and quality of life, earlier clinical remission and less joint damage after 5 years of follow-up than initial monotherapy. From one year onwards clinical outcomes were comparable across the groups. Drug free remission was possible in up to 20% of patients. Besides the primary outcomes of the BeSt study, this thesis de scribes the association between disease activity and functional capacity, the association between clinical signs of synovitis and joint damage progression at joint level, a comparison between disease activity measures and remission criteria, a comparison between radiological scoring methods, an evaluation of the effect of discontinuation of medication in case of low disease activity and remission and the association between disease activity, treatment and blood pressure.

• Disease activity score
• Treat to target
• BeSt study
• Rheumatoid arthritis
• Tumour necrosis factor inhibitor
• Drug free remission
• Joint damage
• Remission
• Sharp-van der Heijde score
• Health assessment questionnaire

• All authors: Klarenbeek, N.B.
• Supervisor: Huizinga, T.W.J.; Lems, W.F.
• Co-supervisor: Allaart, C.F.; Kerstens, P.J.S.M.
• Qualification: Doctor (dr.)
• Awarding Institution: Leiden University Medical Center (LUMC), Leiden University
• Date: 2013-03-21
• ISBN (print): 9789461916310
• Sponsorship: The research was financially supported by the Dutch College of Health Assurances with additional funding by Scheringh-Plough B.V. and Centocor Inc.