title: In early inflammatory polyarthritis more intensive management according to the 2010 ACR/EULAR criteria leads to higher rates of clinical remission: comparison of two cohorts treated according to different treat-to-target protocols.
abstract: OBJECTIVE
  The aim of this study was to compare the 12-month probability of remission in early inflammatory arthritis with a milder treatment based on the 1987 criteria or a more intensive protocol based on the 2010 criteria.
  
  
  METHODS
  Patients with rheumatoid arthritis (RA) or undifferentiated arthritis (UA) (2005-2012) were included. Before October 2010, patients fulfilling the 1987 criteria received methotrexate (MTX) and possibly low-dose prednisone, while UA hydroxychloroquine (HCQ) (1987-driven cohort). From October 2010, patients fulfilling the 2010 criteria received higher dose MTX and low-dose prednisone, while UA HCQ (2010-driven cohort). Treatment was increased to achieve DAS28 low disease activity. Clinical remission, defined by DAS28, was evaluated at subsequent visits in the whole population. Hazard ratios (HR) adjusted for age, sex, baseline DAS28, symptoms duration, MTX dose and prednisone were calculated by Cox regression.
  
  
  RESULTS
  677 patients were included (468 in 1987-driven cohort, 209 in 2010-driven cohort), with no significant differences in age, gender, autoantibodies and pain. The 2010-driven cohort had significantly fewer tender and swollen joints, lower acute phase reactants, DAS28 and HAQ and achieved more frequently remission even when the analysis was adjusted for all confounders (adjusted HR (95% CI) 1.73 (1.34, 2.22)) and limited to per protocol patients (adjusted HR (95%CI) 1.49 (1.11, 2.02).
  
  
  CONCLUSIONS
  Treating patients with early arthritis according to a more intensive protocol leads to higher remission rate. The results of this study support the use of a strategy led by the 2010 criteria with more intensive treatment strategies in the management of early arthritis.
authors.affiliation: Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Balduzzi
authors.affiliation: Italian Society for Rheumatology (SIR), Epidemiology Unit, Milan, Italy.
authors.forename: Carlo Alberto
authors.initials: CA
authors.lastname: Scirè
authors.affiliation: Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy.
authors.forename: Garifallia
authors.initials: G
authors.lastname: Sakellariou
authors.affiliation: Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Benaglio
authors.affiliation: Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Bugatti
authors.affiliation: Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy. montecucco@smatteo.pv.it.
authors.forename: Carlomaurizio
authors.initials: C
authors.lastname: Montecucco
authors.affiliation: Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Caporali
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006886:Hydroxychloroquine / Q000008:administration & dosage*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011241:Prednisone / Q000008:administration & dosage*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012074:Remission Induction; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D006886:Hydroxychloroquine; D011241:Prednisone; D008727:Methotrexate