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26-04-2017 | Rheumatology | News | Article

Early RA treatment associated with lasting gains

medwireNews: Patients with rheumatoid arthritis (RA) who receive early treatment with disease-modifying antirheumatic drugs (DMARDs) or steroids continue to experience therapeutic benefits up to 20 years later, researchers report.

“This research emphasizes the importance of early treatment and the long-term benefits of early treatment,” said study lead Suzanne Verstappen, from The University of Manchester, UK, in a press release.

Verstappen and colleagues analyzed data from 602 participants who were diagnosed with RA and included in the Norfolk Arthritis Register between 1990 and 1994, of whom 160 received treatment within 6 months of symptom onset (early treatment group), 249 received treatment more than 6 months after symptom onset (late treatment group), and 193 received no treatment due to having mild disease (no treatment group). A total of 207 participants attended the 20-year follow-up assessment.

The median swollen joint count (SJC) and tender joint count (TJC) decreased from baseline to year 1 and remained low after 20 years of follow-up (SJC: 11, 3, and 1; TJC: 14, 6, and 4, respectively), with no significant differences between the three groups over follow-up, reports the team in Arthritis & Rheumatology.

However, while overall median health assessment questionnaire (HAQ) scores fell initially, from 1.00 at baseline to 0.75 after 1 year of treatment, they increased over the duration of follow-up to a median score of 1.38 at 20 years.

The authors note that despite this increase in HAQ scores over 20 years, the results are “encouraging” because “[a] score of 1.38 represents low to moderate disability,” and an earlier study following patients diagnosed with RA in the 1960s “reported much higher levels of disability at 20 years.”

They say, therefore, that it appears “long-term disability in RA patients is now less severe.”

Of note, in a model accounting for factors including age, gender, smoking status, and time-varying measures, patients who received early DMARD treatment had comparable disability over follow-up to those who did not require treatment (β=0.03), whereas participants in the late treatment group had significantly higher disability than those in the no treatment group (β=0.10).

“This supports the importance of the ‘window of opportunity’ construct for treatment, showing that early treatment leads to improved outcomes even into the second decade following symptom onset,” say Verstappen and team.

The researchers concede that their findings may not be representative of current clinical practice, because the participants were recruited over 20 years ago, and “the standard treatment at the time does not reflect best treatment practices today.”

They add: “Whilst this is a limitation of this project, treatment practices are constantly evolving.”

By Claire Barnard

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