Very early rheumatoid arthritis is the major predictor of major outcomes: clinical ACR remission and radiographic non-progression

Abstract

ObjectivesTo identify predictors of clinical remission as well as of no x-ray progression in a cohort of early rheumatoid arthritis (ERA) treated with a tight-control protocol.MethodsA total of 121 consecutive patients with ERA were treated to reach European League Against Rheumatism (EULAR) and/or American College of Rheumatology (ACR) clinical remission with methotrexate (MTX) for 3 months, then with a combination with anti-tumour necrosis factor if the patient did not achieve a 44-joint Disease Activity Score (DAS44) ≤2.4. At baseline and after 12 months all the patients had hand and foot joint radiographs. Very early rheumatoid arthritis (VERA) was defined as a disease with symptoms of less than 12 weeks.ResultsIn all, 46.3% of the patients reached DAS remission and 24.8% achieved ACR remission. More than 60% of patients reached remission with MTX. Male sex and an erythrocyte sedimentation rate <35 mm/h at onset arose as significant predictors of EULAR remission, while VERA disease was the only predictor of ACR remission. At baseline, 28.1% of the patients were erosive. Multivariate analysis demonstrated that the only independent predictor of erosiveness was ‘not having VERA disease’. After 12 months, VERA was the only factor predicting a lack of new erosions.ConclusionsVERA represents the best therapeutic opportunity in clinical practice to achieve a complete remission and to stop the erosive course of rheumatoid arthritis.

A general practice perspective on early rheumatoid arthritis management: A qualitative study from Flanders

“…Early treatment, as soon as possible and ideally within the 12 weeks after symptom onset, may substantially decrease disability and increase the chance of achieving remission (6,7). Recent research, however, shows a median delay from symptom onset to treatment initiation ranging from 16 to 38 weeks in different countries (8,9).…”

Role of Dickkopf-1 and Musculoskeletal Ultrasound in Bone Loss in Rheumatoid Arthritis

“…This disease is characterized by chronic synovial inflammation and synovial cell proliferation producing the pannus, which is responsible for bone and cartilage destruction [2]. Seventy% of patients reveal an irreversible joint damage after 2 years of disease, but 28% of RA patients already shows erosions at disease onset which is one of the hallmarks of RA [3]. Research on the mechanisms by which RA induces bone erosions has focused on the osteoclast's roles in shifting the normal balance between bone formation and resorption [4].…”

New Recommendations for the Management of Rheumatoid Arthritis (Eular, 2013): The Role of Methotrexate

“…В исследование было включено 110 па-циентов с НДА, которые соответствовали ди-агнозу «вероятного» РА по критериям Амери-канской коллегии ревматологов (ACR) 1958 г. Vermeer M. et al [35,36] Открытое (T2T, 48 мес) (DREAM) МТ (n=534) 0,4 5,0 0,9 при DAS28 ≥2, 6: МТ+СУЛЬФ при DAS28 ≥2,6: МТ+ингибиторы ФНОα Bosello S. et al [37] Открытое (T2T, 24 мес) МТ (n=121) 0,6 3,0** при DAS44 >2,4: МТ+ингибиторы ФНОα Montecucco C. et al [39] Открытое рандомизированное (12 доза 15 мг/нед) с последующим увеличением дозы (макси-мальная доза 30 мг/нед) при сохранении активности забо-левания (значение индекса DAS >2,4), другие получали ПЛ. Через 12 мес лечение было отменено, продолжитель-ность наблюдения за пациентами составила 30 мес.…”

“…В исследовании S. Bosello и соавт. [37], в которое бы-ли включены пациенты с ранним РА, проводилось лечение МТ (максимальная доза 20 мг/нед) и, при необходимости (DAS44 >2,4), комбинированная терапия МТ и ингибито-рами ФНОα. Через 12 мес ремиссии или низкой активно-сти достигли 60,3% больных на монотерапии МТ (24,8% по критериям ACR/EULAR) и 39,7% на комбинированной те-рапии МТ и ингибиторами ФНОα.…”