Background/Purpose:

Recent data have demonstrated that early treatment  with disease modifying anti-rheumatic drugs (DMARDs)  improves outcome in patients with Rheumatoid arthritis (RA). Early arthritis clinic (EAC)  is a  useful tool which allows high risk patients to bypass long waiting times for a rheumatology evaluation and thus start treatment  early. We have used the data from Prague Early Rheumatoid Arthritis Clinic (PERAC)to evaluate first year treatment outcomes  of  patients with early RA.

Methods:

Patients with symptom duration ≤6 months were reffered by their primary care physicians in accordance with published recommendations.  Only patients with rheumatoid arthritis fulfilling the 2010 ACR/EULAR classification criteria or undifferentiated inflammatory arthritis which, at the time of presentation, did not fulfill classification criteria of another disease entity were included in the ERA cohort. There was no pre-specified  treatment protocol in place and  non-biological DMARDs were started  based on the discretion of  treating physician. Clinical and laboratory data were collected at pre-specified time points.

Results:

427 patients were evaluated in the PERAC between 2008 and 2012.  131 of these were included in the ERA cohort. 119  patients (91%) fulfilled RA classification criteria at baseline. 30% of newly diagnosed RA patients had normal CRP (≤0.5 mg/dl).  Most patients were started on methotrexate in accordance with current guidelines.  81% of patients were initially treated by oral glucocorticoids. Data at 12 months were available for 89 patients. Mean age in this subgroup was 51 years, 67% were women, 56% were ACPA and 55% rheumatoid factor positive.  Mean DAS28 score had decreased from 5.50 at baseline to 3.05 after 12 months of treatment. 40 patients (45%) were in remission based on SDAI ≤ 3.3 and 42 patients (47%) fulfilled the ACR/EULAR proposed Boolean-based definition of remission. 12 patients (13%) had to change their initial DMARD during first 12 months of treatment and only 5 patients started on methotrexate (5%)  had to discontinue the drug due to side-effects during the first 12 months of treatment. 50% (4 out of 8) patients not fulfilling RA classification  criteria at baseline were classified as having RA   at month 12.  2 patients (2%)  initially fulfilling RA classification criteria were  diagnosed with another disease (paraneoplastic arthritis and systemic lupus erythematodes) at month 12.

Conclusion:

Our data confirm that early RA patients have a  very good clinical response to initial DMARD choice. Side effects of methotrexate leading to treatment discontinuation were rare.  2010 ACR/EULAR RA classification and provisional remission criteria are applicable in clinical practice. Appropriate refferral of patients at risk by their primary care physicians remains a problem.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/remission-after-twelve-month-of-treatment-in-the-prague-early-rheumatoid-arhritis-cohort/