Remission can be achieved in 50 percent of early rheumatoid arthritis patients after 25 weeks in dai

1
In daily clinical practice remission can be
achieved in 50 percent of early rheumatoid
arthritis patients within 25 weeks
Ina Kuper1, Monique Hoekstra2, Peter ten
Klooster3, Marloes Vermeer1, Cees Haagsma4, Theo
Zijlstra2, Mart van de Laar1,3 Departments of
rheumatology 1Medisch Spectrum Twente, Enschede,
2Isala Klinieken, Zwolle, 4Ziekenhuisgroep
Twente, Almelo/Hengelo, 3Institute for Behavioral
Research, University of Twente, Enschede
RHEUMATOLOGY TWENTE
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Remission is the goal in early RA

• Randomized controlled trials
• Early start of DMARDs (window of opportunity)
• Combination therapy with/without (high) dose
  prednisolone/ anti-TNF
• Tight control
• However
• Established RA (ACR 1987-criteria)
• Active disease ( 6 TJ, 6 SJ, ESR 28,VAS-GH
  20 and/or MS 45 min)
• Methotrexate monotherapy in early RA very
  effective

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Daily clinical practice

• 30-70 of patients are not eligible for these
  studies
• Patients and their doctors are reluctant to start
  with high dose prednisolone
• Guidelines for prescription and reimbursement of
  anti-TNF in the Netherlands
• 2 DMARDs, 1 of them MTX 25 mg/wk
• DAS28 gt 3.2

4
DREAM remission induction cohortDutch Rheumatoid
Arthritis Monitoring

• Observational multicenter tight control daily
  clinical practice study,
• All consecutive patients with recently diagnosed
  RA
• Daily practice accepted step-up DMARD treatment
  scheme
• Aim remission, DAS28lt 2.6
• NSAIDs, prednisolone 10mg/day and
  intra-articular corticosteroid injections are
  allowed

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Treatment schemeNext step DAS282.6, for anti
TNF DAS28gt 3.2
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Statistics

• T-test and Pearson-chi square baseline patient
  characteristics between centers
• Kaplan-Meier survival curves
• time to first remission (DAS28lt2.6, 95 CI,
  weeks)
• time to first low disease activity (DAS3.2)

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Baseline characteristics, n169
mean (SD) unless otherwise noted
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First remission
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Remission and low disease activity at follow-up
()
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Sustained remission?

• 3 months after 1st remission 61.5
• 6 months after 1st remission 53.2

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Medication at first remission
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Discussion

• Start in optimizing therapy in daily practice
• Radiological progression
• Functional outcomes
• Quality of life
• Drug free remission?
• Prognostic factors (Marloes Vermeer)

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Conclusion
In daily clinical practice it is possible to
achieve low disease activity state as well as
remission in patients with recent onset
rheumatoid arthritis adhering to a tight control
step-up DMARD treatment scheme aiming at
remission.
RHEUMATOLOGY TWENTE