Half of patients with recent-onset RA symptom-free within 36 weeks following step-up drug treatment

At least 50% of recent-onset rheumatoid arthritis (RA) patients achieved remission within 36 weeks following a systematic approach of step-up disease-modifying anti-rheumatic drug (DMARD) treatment in combination with tight control, according to the results of a recent trial.

Researchers presented the study findings at the European League Against Rheumatism (EULAR) 2008 Annual Congress in Paris.

As part of the Dutch Rheumatoid Arthritis Monitoring Registry, investigators performed a prospective, descriptive study of a cohort of recent-onset RA patients in daily clinical practice between January 2006 and January 2008. One-hundred ninety consecutive patients with recently diagnosed RA under the care of the rheumatology clinics at three Dutch hospitals were included. Results were taken from the first 169 patients with a Disease Activity Score (DAS28) of 3.2 or greater at inclusion.

Of the 169 patients, 15.5% of patients achieved remission by week 8, 22.2% by week 12, 30.7% by week 20, 38.8% by week 24, 52.1% by week 36 and 51% by weeks 48-52, according to a EULAR press release.

The researchers said they achieved these results through implementation of a tightly regulated DMARD treatment scheme, including:

administration of methotrexate 15 mg/week following diagnosis of RA;
an increase in dosage to 25 mg/week if remission was not achieved by week 8;
addition of sulfasalazine (2 grams/day) if remission was not achieved by week 12;
an increase of sulfasalazine dose to 3 grams/day if remission was not achieved by week 20; and
addition of adalimumab to methotrexate if remission was not achieved by week 24.

Patients were allowed to take NSAIDs, and the physicians could administer prednisolone and intra-articular corticosteroid injections if necessary, according to the abstract.

Co-investigators Ina Kuper and Mart van de Laar said in the EULAR news release, “Our results show that remission is indeed achievable in as many as half of clinical practice patients following this schedule, which could indicate that remission is a realistic treatment goal of daily clinical practice.”

For more information:
Kuper I, Hoekstra M, ten Klooster P, et al. Remission can be achieved in 50% of early rheumatoid arthritis patients after 25 weeks in daily clinical practice. Paper OP-0003. Presented at the European League Against Rheumatism 2008 Annual Congress. June 11-14, 2008. Paris.