Delay to institution of therapy and induction of remission using single-drug or combination antirheumatic drug therapy in early rheumatoid arthritis

The delay of a few months from the onset of symptoms to institution of therapy appears to decrease the ability of the traditional single-drug strategy to induce remission in early RA.

In the FIN-RACo (FINnish Rheumatoid Arthritis Combination therapy) trial , 195 patients with recent-onset RA (median duration 6 months) were randomly assigned to receive either 1) a combination of DMARDs (sulfasalazine, methotrexate, hydroxychloroquine, and prednisolone) or 2) a single DMARD with or without prednisolone. The additional variables of age, sex, presence of rheumatoid factor, number of fulfilled ACR criteria for the classification of RA, and length of delay from onset of symptoms to institution of therapy were entered into a logistic regression model to determine the significant predictors for remission at 2 years. The delay to therapy (cut point of 4 months) was the only significant predictor for remission in patients treated using the single-DMARD strategy, while no variable was a significant predictor for remission in those treated using the combination-DMARD strategy. The frequency of achieving remission in the combination-DMARD group after 2 years was similar in patients with short (0-4 months) and long (> 4 months) delay periods (11 of 26 patients and 22 of 53 patients, respectively (approximately 42 % in each group), while the corresponding frequencies in the single-DMARD group were 8 of 23 patients (35 %) and 7 of 63 patients (11 %) (P = 0.021).

Comment: The quality of evidence is downgraded by imprecise results (limited study size).

Ədəbiyyat

1. Möttönen T, Hannonen P, Korpela M, Nissilä M, Kautiainen H, Ilonen J, Laasonen L, Kaipiainen-Seppänen O, Franzen P, Helve T, Koski J, Gripenberg-Gahmberg M, Myllykangas-Luosujärvi R, Leirisalo-Repo M, FIN-RACo Trial Group. FINnish Rheumatoid Arthritis Combination therapy. Delay to institution of therapy and induction of remission using single-drug or combination-disease-modifying antirheumatic drug therapy in early rheumatoid arthritis. Arthritis Rheum 2002 Apr;46(4):894-8.