A tight control treatment strategy aiming for remission in early rheumatoid arthritis is more effective than usual care treatment in daily clinical practice: a study of two cohorts in the Dutch Rheumatoid Arthritis Monitoring registry.
There is strong evidence from clinical trials that a 'treat to target' strategy is effective in reaching remission in rheumatoid arthritis (RA). However, the question is whether these results can be translated into daily clinical practice and clinical remission is a reachable target indeed.


OBJECTIVE
The study aims to investigate whether in early RA a treatment strategy aiming at Disease Activity Score (DAS) 28 <2.6 is more effective than 'usual care' treatment for reaching clinical remission after 1 year.


METHODS
Two early RA inception cohorts from two different regions including patients who fulfilled the American College of Rheumatology criteria for RA were compared. Patients in the tight-control cohort (n=126) were treated according to a DAS28-driven step-up treatment strategy starting with methotrexate, addition of sulphasalazine (SSZ) and exchange of SSZ by anti-tumour necrosis factor in case of failure. Patients in the usual-care cohort (n=126) were treated with methotrexate or SSZ, without DAS28-guided treatment decisions. The primary outcome was the percentage remission (DAS28<2.6) at 1 year. Time to first remission and change in DAS28 were secondary outcomes.


RESULTS
After 1 year, 55% of tight-control patients had a DAS28<2.6 versus 30% of usual care patients (OR 3.1, 95% CI 1.8 to 5.2). The median time to first remission was 25 weeks for tight control and more than 52 weeks for usual care (p<0.0001). The DAS28 decreased with -2.5 in tight control and -1.5 in usual care (p<0.0001).


CONCLUSIONS
In early RA, a tight control treatment strategy aiming for remission leads to more rapid DAS28 remission and higher percentages of remission after 1 year than does a usual care treatment.
Department of Rheumatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Lydia G
LG
Schipper
Marloes
M
Vermeer
Hillechiena H
HH
Kuper
Monique O
MO
Hoekstra
Cees J
CJ
Haagsma
Alfons A
AA
Den Broeder
Piet
P
van Riel
Jaap
J
Fransen
Mart A F J
MA
van de Laar
D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D009426:Netherlands; D012042:Registries / Q000706:statistics & numerical data*; D012074:Remission Induction; D012720:Severity of Illness Index; D012460:Sulfasalazine / Q000008:administration & dosage* / Q000009:adverse effects
D018501:Antirheumatic Agents; D012460:Sulfasalazine; D008727:Methotrexate