title: In early rheumatoid arthritis, patients with a good initial response to methotrexate have excellent 2-year clinical outcomes, but radiological progression is not fully prevented: data from the methotrexate responders population in the SWEFOT trial.
abstract: OBJECTIVE
  To investigate the 2-year clinical and radiological outcomes of patients with early rheumatoid arthritis (RA; symptom duration <1 year) who had initially responded well to methotrexate monotherapy.
  
  
  METHODS
  In the SWEFOT trial, all 487 patients started methotrexate (target dose 20 mg/week). After 3-4 months, 147 had low disease activity, 28-joint based disease activity score (DAS28) ≤3.2. These patients were not randomly selected but were followed in regular care for 2 years. Clinical outcomes and radiographic progression according to the van der Heijde modified Sharp (SvdH) score were analysed.
  
  
  RESULTS
  The majority of the 147 patients continued on methotrexate monotherapy. After 1 and 2 years, DAS28 remission was achieved in 59.6% and 71.8% and mean observed DAS28 values were 2.53 and 2.25, respectively. Despite the favourable clinical course, a proportion of the patients progressed radiographically with a mean (SD) increase in the SvdH score after 2 years of 3.90 (6.84). There was no significant difference in progression between patients in DAS28 remission versus not in remission (p=0.73). At baseline, approximately half the patients had no radiographic damage, while after 2 years the proportion was approximately 20%.
  
  
  CONCLUSIONS
  Most early RA patients who achieve low disease activity after 3-4 months of methotrexate monotherapy continue to have low disease activity during 2 years follow-up, and additional treatment is needed infrequently. Some radiological progression occurs in most patients, and may be marked or severe in some, even despite sustained DAS28 remission. Close monitoring for radiological progression is thus warranted.
authors.affiliation: Unit of Clinical Therapy Research, Inflammatory Diseases, The Karolinska Institute, Stockholm, Sweden. hamed.rezaei@karolinska.se
authors.forename: Hamed
authors.initials: H
authors.lastname: Rezaei
authors.forename: Saedis
authors.initials: S
authors.lastname: Saevarsdottir
authors.forename: Kristina
authors.initials: K
authors.lastname: Forslind
authors.forename: Kristina
authors.initials: K
authors.lastname: Albertsson
authors.forename: Helena
authors.initials: H
authors.lastname: Wallin
authors.forename: Johan
authors.initials: J
authors.lastname: Bratt
authors.forename: Sofia
authors.initials: S
authors.lastname: Ernestam
authors.forename: Pierre
authors.initials: P
authors.lastname: Geborek
authors.forename: Ingemar F
authors.initials: IF
authors.lastname: Pettersson
authors.forename: Ronald F
authors.initials: RF
authors.lastname: van Vollenhoven
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy*; D004185:Disability Evaluation; D018450:Disease Progression; D004359:Drug Therapy, Combination; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D011859:Radiography; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D008727:Methotrexate