title: Treatment discontinuation in patients with very early rheumatoid arthritis in sustained simplified disease activity index remission after synthetic disease-modifying anti-rheumatic drug administration.
abstract: We aimed to identify whether drug-free remission could be achieved in patients with very early rheumatoid arthritis (RA) with poor prognosis factors by treatment with synthetic disease-modifying antirheumatic drugs (DMARDs). Thirteen patients with very early RA, whose disease was considered to have highly erosive potential, were included. Magnetic resonance imaging (MRI)-proven bone edema and autoantibodies were determined in these patients. A treat-to-target strategy initiated with synthetic DMARDs was employed for 12 months. If the patients achieved simplified disease activity index (SDAI) remission along with a reduction of the RA MRI scoring bone edema score to <33% as compared with baseline at 12 months, DMARD treatment was stopped and the clinical status was further observed for the following 12 months. Synthetic DMARDs were stopped at 12 months in 5 patients. One of the 5 was lost to follow-up because of sustaining an injury that required orthopedic surgery. Three of the remaining 4 patients showed continued SDAI remission that was DMARD-free without any evidence of radiographic progression for the following 12 months. Although this was a small clinical trial, we have shown-for the first time-that true remission of very early RA with poor prognosis factors can be achieved by treatment with synthetic DMARDs.
authors.affiliation: Unit of Translational Medicine, Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Kita
authors.forename: Mami
authors.initials: M
authors.lastname: Tamai
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Arima
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Nakashima
authors.forename: Takahisa
authors.initials: T
authors.lastname: Suzuki
authors.forename: Shin-Ya
authors.initials: SY
authors.lastname: Kawashiri
authors.forename: Naoki
authors.initials: N
authors.lastname: Iwamoto
authors.forename: Akitomo
authors.initials: A
authors.lastname: Okada
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Koga
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamasaki
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakamura
authors.forename: Tomoki
authors.initials: T
authors.lastname: Origuchi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ida
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Aoyagi
authors.forename: Masataka
authors.initials: M
authors.lastname: Uetani
authors.forename: Katsumi
authors.initials: K
authors.lastname: Eguchi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kawakami
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy*; D001175:Arthrography; D018450:Disease Progression; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D012074:Remission Induction; D012720:Severity of Illness Index; D016896:Treatment Outcome; D028761:Withholding Treatment
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids; D008727:Methotrexate