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Antimalarials alone may slow RA disease progression in certain patients
Antimalarial drug therapy alone may be effective at slowing or stopping disease progression for certain patients with rheumatoid arthritis; however, objectively measuring which factors contribute to good treatment response is a challenge, according to researchers at the University of Alberta.
The researchers retrospectively identified 33 patients with rheumatoid arthritis (RA) who were treated solely with antimalarial drugs (15 with chloroquine, 18 with hydroxychloroquine) and appeared to be in remission. Eleven patients were men with a mean age at diagnosis of 57.2 years, and 22 patients were women with a mean age at diagnosis of 48 years. All patients met the 2010 American College of Rheumatology classification for RA. Unknown smoking history was present in 33% of patients, and 54.5% were known smokers. No antinuclear antibody (ANA) results were available for seven patients.
Patient data were compared. Of the patients studied, 73% were rheumatoid factor (RF)-positive, 75% were anti-CCP-positive, 9% were seronegative and 39% were ANA-positive. Other data, such as age, sex, age at the time of diagnosis, disease duration, the number of joints involved, smoking status, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), ANAs, RF and anti-cyclic citrullinated peptide (ACCP) status, were collected at baseline and follow-up, and imaging results were included, as well, if available.
Twenty-three patients (70%) had symptom duration of less than 1 year prior to antimalarial treatment initiation. Both large and small joints were involved among the patients, although small and multiple joints were more common, according to the researchers.
Twenty-five (75%) of the patients presented no joint erosion before or after treatment; patients with erosions at baseline remained stable, and 91% of patients presented with no joint space narrowing.
Based on the data, the researchers concluded the absence of smoking, early intervention, a trend toward smaller joint involvement and low disease activity at initiation were likely factors related to successful treatment with antimalarial drugs alone but more research is needed to predict which patients may respond well to initial therapy with antimalarials alone. - by Shirley Pulawski
Disclosure: The researchers report no relevant financial disclosures.