Early versus delayed treatment in patients with recent-onset rheumatoid arthritis: comparison of two cohorts who received different treatment strategies.
OBJECTIVE
To compare the effect of delayed and early treatment strategies on disease outcome in patients with rheumatoid arthritis.


METHODS
Between 1993 and 1995, 109 patients diagnosed with probable or definite rheumatoid arthritis of recent onset were initially treated with analgesics; if they had persistent active disease, they were treated subsequently with the disease-modifying drugs chloroquine or salazopyrine (delayed treatment). Between 1996 and 1998, similar patients (n = 97) were promptly treated with either chloroquine or salazopyrine (early treatment).


RESULTS
The median lag to the initiation of disease-modifying treatment was 15 days in the early treatment group and 123 days in the delayed treatment group. There was less radiologic joint damage after 2 years in the early treatment group (median Sharp score, 3.5; 95% confidence interval [CI]: 1 to 7) compared with the delayed treatment group (median Sharp score, 10; 95% CI: 5 to 15; P <0.05). The median area under the curve of the 2-year disease activity score was lower in the early treatment group (64 units; 95% CI: 59 to 69 units) compared with the delayed treatment group (73 units; 95% CI: 69 to 77 units; P = 0.002).


CONCLUSIONS
In this nonrandomized comparison, early introduction of disease-modifying antirheumatic drugs was associated with a better disease outcome after 2 years.
Lard
L R
LR
Department of Rheumatology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands.
Visser
H
H
Speyer
I
I
vander Horst-Bruinsma
I E
IE
Zwinderman
A H
AH
Breedveld
F C
FC
Hazes
J M
JM
D000203:Activities of Daily Living; D000328:Adult; D000367:Age Factors; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D002738:Chloroquine / Q000627:therapeutic use*; D015331:Cohort Studies; D018450:Disease Progression; D004338:Drug Combinations; D005260:Female; D005528:Foot / Q000000981:diagnostic imaging; D005944:Glucosamine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D006225:Hand / Q000000981:diagnostic imaging; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011859:Radiography; D012460:Sulfasalazine / Q000627:therapeutic use*; D013997:Time Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D004338:Drug Combinations; C028423:Salazopyrine; D012460:Sulfasalazine; D002738:Chloroquine; D002097:C-Reactive Protein; D005944:Glucosamine