title: DAS-driven therapy versus routine care in patients with recent-onset active rheumatoid arthritis.
abstract: OBJECTIVE
  To compare the efficacy of Disease Activity Score (DAS)-driven therapy and routine care in patients with recent-onset rheumatoid arthritis.
  
  
  METHODS
  Patients with recent-onset rheumatoid arthritis receiving traditional antirheumatic therapy from either the BeSt study, a randomised controlled trial comparing different treatment strategies (group A), or two Early Arthritis Clinics (group B) were included. In group A, systematic DAS-driven treatment adjustments aimed to achieve low disease activity (DAS < or =2.4). In group B, treatment was left to the discretion of the treating doctor. Functional ability (Health Assessment Questionnaire (HAQ)), Disease Activity Score in 28 joints (DAS28) and Sharp/van der Heijde radiographic score (SHS) were evaluated.
  
  
  RESULTS
  At baseline, patients in group A (n = 234) and group B (n = 201) had comparable demographic characteristics and a mean HAQ of 1.4. Group A had a longer median disease duration than group B (0.5 vs 0.4 years, p = 0.016), a higher mean DAS28 (6.1 vs 5.7, p<0.001), more rheumatoid factor-positive patients (66% vs 42%, p<0.001) and more patients with erosions (71% vs 53%, p<0.001). After 1 year, the HAQ improvement was 0.7 vs 0.5 (p = 0.029), and the percentage in remission (DAS28 <2.6) 31% vs 18% (p<0.005) in groups A and B, respectively. In group A, the median SHS progression was 2.0 (expected progression 7.0), in group B, the SHS progression was 1.0 (expected progression 4.4).
  
  
  CONCLUSIONS
  In patients with recent-onset rheumatoid arthritis receiving traditional treatment, systematic DAS-driven therapy results in significantly better clinical improvement and possibly improves the suppression of joint damage progression.
authors.affiliation: Leiden University Medical Centre, Department of Rheumatology C-1-R, PO Box 9600, 2300 RC Leiden, The Netherlands. y.p.m.goekoop@lumc.nl
authors.forename: Y P M
authors.initials: YP
authors.lastname: Goekoop-Ruiterman
authors.forename: J K
authors.initials: JK
authors.lastname: de Vries-Bouwstra
authors.forename: P J S M
authors.initials: PJ
authors.lastname: Kerstens
authors.forename: M M J
authors.initials: MM
authors.lastname: Nielen
authors.forename: K
authors.initials: K
authors.lastname: Vos
authors.forename: D
authors.initials: D
authors.lastname: van Schaardenburg
authors.forename: I
authors.initials: I
authors.lastname: Speyer
authors.forename: P E H
authors.initials: PE
authors.lastname: Seys
authors.forename: F C
authors.initials: FC
authors.lastname: Breedveld
authors.forename: C F
authors.initials: CF
authors.lastname: Allaart
authors.forename: B A C
authors.initials: BA
authors.lastname: Dijkmans
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy*; D018450:Disease Progression; D004334:Drug Administration Schedule; D016903:Drug Monitoring / Q000379:methods; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents