title: Combination drug strategy in recent-onset rheumatoid arthritis suppresses collagen I degradation and is associated with retardation of radiological progression.
abstract: OBJECTIVE
  To assess whether serum C-terminal cross-linking telopeptide of type I collagen (ICTP), a marker of type I collagen degradation, has any additional value in the assessment of treatment effect in patients with early rheumatoid arthritis (RA).
  
  
  METHODS
  A total of 182 patients were randomized to treatment either with three disease-modifying anti-rheumatic drugs (DMARDs) and low-dose prednisolone (COMBI) or with a single DMARD with or without low-dose prednisolone (SINGLE). We investigated the prognostic value of serum ICTP level for the progression of joint destruction in X-rays (Larsen's score) from baseline to 2 years.
  
  
  RESULTS
  There was a statistically significant decrease in serum ICTP levels from baseline to 1 year. At 6 months, the serum ICTP level was lower in the COMBI patients compared to that of the SINGLE cases (p = 0.008, after adjustment for baseline ICTP). When grouping the patients according to serum ICTP tertiles at 6 months, there was a statistically significant trend for increasing median change in Larsen score from baseline to 2 years from lowest to highest ICTP tertile in the SINGLE patients [p = 0.008, after adjustment for 28-joint Disease Activity Score (DAS28) score and RF status at baseline], while in the COMBI, the change remained low in all ICTP tertiles.
  
  
  CONCLUSIONS
  The COMBI strategy for recent-onset RA results in early suppression of type I collagen degradation, which is reflected in radiological joint damage at 2 years. Serum ICTP at 6 months may be useful for identifying those RA patients whose treatment should be intensified to prevent further joint damage.
authors.affiliation: Rheumatism Foundation Hospital, Heinola, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Hakala
authors.forename: J
authors.initials: J
authors.lastname: Risteli
authors.forename: S
authors.initials: S
authors.lastname: Aman
authors.forename: H
authors.initials: H
authors.lastname: Kautiainen
authors.forename: M
authors.initials: M
authors.lastname: Korpela
authors.forename: P
authors.initials: P
authors.lastname: Hannonen
authors.forename: M
authors.initials: M
authors.lastname: Leirisalo-Repo
authors.forename: L
authors.initials: L
authors.lastname: Laasonen
authors.forename: L
authors.initials: L
authors.lastname: Paimela
authors.forename: T
authors.initials: T
authors.lastname: Möttönen
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000097:blood* / Q000188:drug therapy* / Q000503:physiopathology; D001175:Arthrography; D015415:Biomarkers / Q000097:blood; D024042:Collagen Type I / Q000097:blood*; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007596:Joints / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000097:blood*; D011239:Prednisolone / Q000627:therapeutic use*; D012720:Severity of Illness Index
chemical_list: D018501:Antirheumatic Agents; D015415:Biomarkers; D024042:Collagen Type I; D010455:Peptides; C052929:collagen type I trimeric cross-linked peptide; D011239:Prednisolone