The good initial response to therapy with a combination of traditional disease‐modifying antirheumatic drugs is sustained over time: The eleven‐year results of the Finnish rheumatoid arthritis combination therapy trial

Rantalaiho, Vappu; Korpela, Markku; Hannonen, Pekka; Kautiainen, Hannu; Järvenpää, Salme; Leirisalo‐Repo, Marjatta; Hakala, M; Puolakka, Kari; Julkunen, Heikki; Luosujärvi, Riitta; Möttönen, Timo

doi:10.1002/art.24447

Cited by 76 publications

(51 citation statements)

References 30 publications

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“…In the FINRACo (Finnish Rheumatoid Arthritis Combination Therapy) trial treatment was targeted at remission during 5 years (22). After 11 years, 138 of 195 randomized patients (71%) responded to the recall.…”

Section: Discussionmentioning

confidence: 99%

Continued Participation in a Ten‐Year Tight Control Treat‐to‐Target Study in Rheumatoid Arthritis: Why Keep Patients Doing their Best?

Markusse

Dirven

Han

et al. 2015

Arthritis Care & Research

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Objective. To identify risk factors for early study termination and motivators for adherence to a long-term followup trial and to improve completeness of long-term studies. Methods. Risk factors for early termination in 508 included patients were identified through Cox regression analysis. Patients completing the 10-year followup filled in a questionnaire on possible motives for continued study participation. Results. Risk factors for early termination were higher age (hazard ratio [HR] 1.03, 95% confidence interval [95% CI] 1.02-1.04), functional disability during the preceding year (HR 1.54, 95% CI 1.20-1.99), having achieved drug-free remission (HR 6.62, 95% CI 2.07-21.14), limited joint damage (HR 0.98, 95% CI 0.97-0.995 for actual damage; HR 0.83, 95% CI 0.73-0.94 for damage progression), and few adverse events (HR 0.35, 95% CI 0.26-0.47). A total of 288 of 313 patients (92%) attending the last visit answered the questionnaire. The majority mentioned contributing to scientific research (97% agreed), helping other patients (91%), and learning about new treatment strategies (84%) and their disease (85%) as reasons to continue participation. Next, patients mentioned tight control (202 of 278 patients), good treatment strategy (128 of 278), good medication (117 of 278), and good half-term results (102 of 278) as motivators. More than 95% of patients experienced participation "as expected" or "better than expected." Additional examinations during yearly visits (extra questionnaires, imaging) were mentioned as "worse than expected" (10%), as was answering routine questionnaires (7%). Conclusion. Continued participation was relatively high in the Treatment Strategies for Rheumatoid Arthritis (BeSt) Study. Higher age, functional disability, drug-free remission, little joint damage, and few adverse events predicted early study termination. Main motives for continued participation were a willingness to contribute to research, help future patients, and because patients had good experiences with the study protocol.

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Section: Discussionmentioning

confidence: 99%

Continued Participation in a Ten‐Year Tight Control Treat‐to‐Target Study in Rheumatoid Arthritis: Why Keep Patients Doing their Best?

Markusse

Dirven

Han

et al. 2015

Arthritis Care & Research

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“…Attraverso le numerose interviste è stato ricostruito il percorso spesso lungo e tortuoso di riconoscimento della malattia, in cui il tempo tra la comparsa dei primi sintomi e la diagnosi di AR oscilla, mediamente, intorno ad un anno, con situazioni fortemente differenziate ed in larga misura collegate alla tipologia del primo professionista che ha preso in carico il paziente ed all'area di residenza. Le difficoltà di pervenire ad una diagnosi definitiva hanno effetti sul decorso della malattia, poiché rendono, di fatto, impraticabile un'azione terapeutica precoce capace di migliorare le prospettive ed il livello di qualità di vita dei pazienti (20,21,27) ma, nello stesso tempo, fanno supporre anche un consistente sommerso di malati non diagnosticati che non riescono ancora oggi ad accedere alle cure più appropriate. Anche il rapporto con i servizi sanitari si è rivelato non privo di elementi di criticità: se è vero che la maggior parte dei pazienti ha nel reumatologo la figura di riferimento centrale per la cura della AR (ma non va dimenticato che si tratta di un campione selezionato proprio in base al fatto di aver ottenuto la diagnosi da un reumatologo), non mancano significative variazioni legate al livello di istruzione dei pazienti (più è elevato più è comune il ricorso al reumatologo), all'età (tra gli anziani prevale la tendenza a far riferimento al MMG) e la zona di residenza (il ricorso al reumatologo privato è più comune al Sud).…”

Section: Discussioneunclassified

“…Il trattamento "di fondo" dell'AR ha come finalità principale quella di indurre la remissione della flogosi e di arrestare l'evoluzione del danno anatomico. I farmaci utilizzati a tale scopo rientrano del gruppo dei cosiddetti Disease Modifying Anti-Rheumatic Drug (DMARD) e comprendono un'ampia ed eterogenea gamma di molecole (idrossiclorochina, sulfasalazina, sali d'oro, methotrexate, leflunomide, ciclosporina A) (20)(21)(22). Negli ultimi anni, alle terapie tradizionali, si è affiancata una nuova classe di farmaci, i cosiddetti "biologici", che agendo su specifici "target" molecolari e/o cellulari, interferiscono con i meccanismi patogenetici della malattia.…”

Section: The Research Carried Out By Censis Foundation In Collaboratunclassified

Socio-demographic aspects and therapeutic pathways in patients with rheumatoid arthritis in Italy

Salaffi¹,

Vaccaro²,

Manacorda³

et al. 2011

Reumatismo

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INTRODUZIONE L'artrite reumatoide (AR) è una malattia infiammatoria cronica, di eziologia sconosciuta, a patogenesi autoimmune, dominata da un processo di sinovite cronica prevalentemente a carico delle piccole e delle grandi articolazioni diartrodali, ad impronta destruente, spesso associata con la positività del fattore reumatoide (FR). L'AR presenta un'espressività clinica polimorfa, in rapporto alla topografia, al grado d'evoluzione dell'impegno articolare ed alla possibile presenza di manifestazioni extra-articolari. Questo quadro clinico è spesso aggravato da astenia, depressione e deterioramento della sfera psicologica e delle relazioni sociali (1-4). La prevalenza della malattia in Italia è nell'ordine dello 0,33-0,46% (5, 6) con netta predilezione per il sesso femminile (rapporto uomini:donne di 1:3). Tale tasso di prevalenza è del tutto simile a quello rilevato in altre regioni Europee (0,54-0,8%) (7-13) o in popolazioni Turche (0,49%) (14) o Brasiliane (0,46%) (15), ma più elevato dei tassi documentati in popolazioni Asia- Reumatismo, 2009; 61(3):197-211 SUMMARY The research carried out by Censis Foundation, in collaboration with SIR (Italian Society of Rheumatology) and AN-MAR (National Association of Rheumatic patients), with the sponsorship of Roche S.p.A., involved more than 600 patients, diagnosed with arthritis by a rheumatologist according to ACR criteria. The patients were recruited through a representative sample of 300 general practitioners. A number of different research and survey tools were used to collect data, helping to identify several of the problems that affect Italian patients: a survey form to be filled by the GPs, in order to verify the diagnosis and the comorbidity level; a questionnaire for the self-assessment of the disease activity, Rheumatoid Arthritis Disease Activity Index (RADAI), and a sociological questionnaire set up for the analysis of the main aspects of the patients' path. Among the most serious criticalities found, the difficulties and the time needed for the patients to get a clear AR diagnosis, the problems in interacting with health structures, and the differences in accessing pharmaceutical therapies (only a slight majority of patients use DMARDs drugs, a small amount takes biological drugs, while a large number of patients is treated exclusively with symptomatic drugs) stand out. The differences in patients' condition appear then to be exaggerated, regarding the chances to get an early diagnosis, the access path to specialised centres, and in receiving the most appropriate treatments. Moreover, these differences appear to be strongly dependent on both the social characteristics of the patients and the supply arrangement in their area.

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“…[122] It was reported in the FINRACo and BeST studies conducted using the Finnish registry of RA patients that early DMARD combination treatments were more effective in attaining low disease activity and remission compared with DMARD monotherapies, and the effect lasted for a longer period of time. [123,124] The CAMERA study conducted using the Dutch registry showed that remission rates were higher in RA patients under intensive treatment and tight monitoring of monthly follow-up. [24] Ferraccioli et al [125] and Verschueren et al [126] also reported that intensive treatment was more effective and was associated with more rapid clinical response.…”

Section: The Use Of Synthetic Dmards Such As Azathioprine Cyclosporimentioning

confidence: 99%

Management of Rheumatoid Arthritis: Consensus Recommendations From the Turkish League Against Rheumatism

Ataman

2011

Turk J Rheumatol

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The good initial response to therapy with a combination of traditional disease‐modifying antirheumatic drugs is sustained over time: The eleven‐year results of the Finnish rheumatoid arthritis combination therapy trial

Cited by 76 publications

References 30 publications

Continued Participation in a Ten‐Year Tight Control Treat‐to‐Target Study in Rheumatoid Arthritis: Why Keep Patients Doing their Best?

Continued Participation in a Ten‐Year Tight Control Treat‐to‐Target Study in Rheumatoid Arthritis: Why Keep Patients Doing their Best?

Socio-demographic aspects and therapeutic pathways in patients with rheumatoid arthritis in Italy

Management of Rheumatoid Arthritis: Consensus Recommendations From the Turkish League Against Rheumatism

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