Background/Purpose: There is no doubt that early treatment of rheumatoid arthritis (RA) with disease-modifying anti-rheumatic drugs (DMARDs) is associated with better long-term outcomes. However, the time frame of early treatment has not been clearly established. Previously, we reported in our cohort of RA patients that those treated with DMARDs within 6 months of disease onset had less physical damage and functional impairment than those treated ≥6 months. Now, we sought to determine if a narrower therapeutic window (< 3 months) would be even more effective.

Methods: A cohort of Hispanics from Puerto Rico with RA (per 1987 American College of Rheumatology classification criteria) was studied. Demographic features, lifestyle behaviors, RA clinical manifestations, disease activity (per Disease Activity Score 28 [DAS-28]), functional status (per Health Assessment Questionnaire [HAQ]), patient’s and physician’s global assessments (by visual analogue scales), infections, hospitalizations, and RA pharmacotherapy were determined. Very early treatment (VET) was defined as the initiation of DMARDs (synthetic and/or biological) < 3 months of symptoms attributable to RA, whereas early treatment (EA) was defined as DMARDs treatment ≥3 but < 6 months from RA onset. Study groups were compared using chi-squared, Fisher’s exact, Mann Whitney or Student’s t tests, as appropriate.

Results: The cohort comprised 394 RA patients, but for this analysis, only those who received VET (n=75) and ET (n=43) were included, for a total of 118 patients. The mean age and disease duration of the study population were 53.7 ± 13.6 and 7.5 ± 7.1 years, respectively. The majority of patients were women (87.3%). Both groups were comparable regarding age, sex, socioeconomic status, disease duration, and health-related behaviors (cigarette smoking, alcohol consumption, and exercise).  During the disease course, no significant differences were observed for joint deformities (33.3% vs. 37.2%, p=0.670), requirement of intra-articular joint injections (37.3% vs. 41.9%, p=0.627), joint replacement surgeries (10.7% vs. 4.65%, p=0.259), extra-articular manifestations (38.7% vs. 48.8%, p=0.282), infections (any cause) (46.7% vs. 53.5%, p=0.476), and mean hospitalizations (any cause) (0.1 ± 0.5, p=0.635) between VET and ET groups. Also, at last study visit no differences were seen for mean DAS-28 (3.6 ± 1.3 vs. 3.5 ± 1.5, p=0.534), HAQ (1.0 ± 0.7 vs. 0.8 ± 0.7, p= 0.07), patient’s global assessment (43.9 ± 28.9 vs. 38.5 ± 25.7, p=0.376) and physician’s global assessment (17.0 ± 18.4 vs. 17.4 ± 19.3, p=0.888) scores. Initial and cumulative treatment with synthetic and biological DMARDs was similar for both groups.

Conclusion: In this group of Puerto Ricans with RA, we found no differences in the clinical outcomes of patients treated with DMARDs < 3 months vs. 3-6 months from onset of RA symptoms. Thus, the therapeutic window of < 6 months seems reasonable for this group of patients. This information is valuable when designing strategies of early intervention for patients with inflammatory arthritis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/early-treatment-of-rheumatoid-arthritis-with-disease-modifying-anti-rheumatic-drugs-at-3-versus-3-6-months-from-onset-of-symptoms-results-from-a-cohort-of-hispanics-from-puerto-rico/