A tight control treatment strategy aiming for remission in early rheumatoid arthritis is more effective than usual care treatment in daily clinical practice: a study of two cohorts in the Dutch Rheumatoid Arthritis Monitoring registry

作者：Schipper Lydia G; Vermeer Marloes; Kuper Hillechiena H; Hoekstra Monique O; Haagsma Cees J; Den Broeder Alfons A; van Riel Piet; Fransen Jaap^*; van de Laar Mart A F J

来源：Annals of the Rheumatic Diseases, 2012, 71(6): 845-850.

DOI：10.1136/annrheumdis-2011-200274

There is strong evidence from clinical trials that a %26apos;treat to target%26apos; strategy is effective in reaching remission in rheumatoid arthritis (RA). However, the question is whether these results can be translated into daily clinical practice and clinical remission is a reachable target indeed. %26lt;br%26gt;Objective The study aims to investigate whether in early RA a treatment strategy aiming at Disease Activity Score (DAS) 28 %26lt;2.6 is more effective than %26apos;usual care%26apos; treatment for reaching clinical remission after 1 year. %26lt;br%26gt;Methods Two early RA inception cohorts from two different regions including patients who fulfilled the American College of Rheumatology criteria for RA were compared. Patients in the tight-control cohort (n=126) were treated according to a DAS28-driven step-up treatment strategy starting with methotrexate, addition of sulphasalazine (SSZ) and exchange of SSZ by anti-tumour necrosis factor in case of failure. Patients in the usual-care cohort (n=126) were treated with methotrexate or SSZ, without DAS28-guided treatment decisions. The primary outcome was the percentage remission (DAS28%26lt;2.6) at 1 year. Time to first remission and change in DAS28 were secondary outcomes. %26lt;br%26gt;Results After 1 year, 55% of tight-control patients had a DAS28%26lt;2.6 versus 30% of usual care patients (OR 3.1, 95% CI 1.8 to 5.2). The median time to first remission was 25 weeks for tight control and more than 52 weeks for usual care (p%26lt;0.0001). The DAS28 decreased with -2.5 in tight control and -1.5 in usual care (p%26lt;0.0001). %26lt;br%26gt;Conclusion In early RA, a tight control treatment strategy aiming for remission leads to more rapid DAS28 remission and higher percentages of remission after 1 year than does a usual care treatment.

• 出版日期2012-6