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Early versus Delayed Treatment in Patients with Recentonset Rheumatoid Arthritis: Comparison of Two

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Early versus Delayed Treatment in Patients with Recent ... Lard, L., H. Visser, I. Speyer, I. vander Horst-Bruinsma, A. Zwinderman, F. Breedveld, J. Hazes. ... – PowerPoint PPT presentation

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Title: Early versus Delayed Treatment in Patients with Recentonset Rheumatoid Arthritis: Comparison of Two


1
Early versus Delayed Treatment in Patients with
Recent-onset Rheumatoid Arthritis Comparison of
Two Cohorts Who Received Different Treatment
Strategies
  • Lard, L., H. Visser, I. Speyer, I. vander
    Horst-Bruinsma, A. Zwinderman, F. Breedveld, J.
    Hazes. 2001. American Journal of Medicine.
    October 111(6) 446-451.
  • Presented by Wislaine Coby

2
What is rheumatoid arthritis?
  • An autoimmune disease that causes chronic
    inflammation of the joints.
  • Two million Americans are affected of all ages.
  • Most common in women

3
Cause
  • The cause is not known
  • Suspicions of infectious agents such as viruses
    and bacteria but no proof as the cause.
  • May be genetically inherited

4
Signs and Symptoms
  • Stiffness
  • Pain
  • Swelling
  • Redness
  • Fatigue

5
Normal and Arthritic Joint
6
Diagnosis of Definite or Probable RA
  • Morning stiffness for more the 30 minutes
  • More than five swollen joints
  • Ritchie score greater than 15
  • Erythrocyte sedimentation rate greater than 28
    mm/h

7
Other Requirements
  • Radiographic joint damage, measured by modified
    Sharp score
  • Health assessment questionnaire
  • Modified disease activity score
  • C-reactive protein level

8
Treatment Strategies
  • (DMARD) disease modifying antirheumatic
    drughelps to slow the progression of the disease
  • (NSAID) nonsteroidal anti-inflammatory
    drugsreduces pain and inflammation.
  • Early treatment (DMARD) disease modifying
    antirheumatic drug and (NSAID) nonsteroidal
    anti-inflammatory drugs (two weeks after)
  • Delayed treatment(NSAID) nonsteroidal
    anti-inflammatory drugs and (DMARD) disease
    modifying antirheumatic drug (used after several
    months)

9
Prescribed dose on type of DMARD
  • Chloroquine 300 mg/day for the first month
  • Salazopyrine 2000 mg/day

10
Results of study
  • From 1993 of January to 1995 of December, 109
    patients with probable or definite disease were
    included.
  • From 1996 of January 1998 of December, 97
    patients with arthritis were included.

11
Characteristics of the two groups
12
Chart Analysis
  • Patients in the early treatment group showed very
    little progression of joint destruction

13
Treatment with dmd
14
Modified Sharp Score
  • Progression of radiographic joint damage was the
    same at 6 months for both group.
  • Early stabilized at 3.5
  • Delayed progressed at 10

15
Median Disease Activity Score/C-reactive Protein
Level
  • Early treatment showed greater improvement for
    the mdas
  • Low levels in the Crpl (322) and the mdas (64)
  • Delayed had high levels in the Crpl (486) and
    mdas (73)
  • C-reactive Protein Level

16
Side Effects
  • Delayed
  • 3patients had to change initial therapy due to
    side effects
  • First treatment changed because lack of efficacy
    in 10 patients.
  • 4 patients changed initial therapy without dmard
  • Early
  • 12 patients changed treatment due to adverse
    affects
  • 21 patients discontinued treatment due to lack of
    efficacy.
  • 8 patients changed initial therapy without dmard

17
Conclusion
  • Early treatment is crucial to reduce any
    symptoms, maximize joint function and prevent
    joint destruction and deformity.
  • DMAD has very little side effects and is a better
    drug to treat patients with early RA.

18
QUESTIONS
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