In early inflammatory arthritis, higher rates of remission are achieved if treatment is started early with conventional therapies and patients are more closely followed, according to research presented at the 2007 American College of Rheumatology Annual Scientific Meeting in Boston.
Using the Toronto Early Arthritis CoHort, a prospective observational cohort of 103 patients with early inflammatory arthritis, investigators set out to determine how many patients reached remission 12 months after the initiation of DMARD (disease-modifying antirheumatic drug) therapy. Investigators also compared the different methods of measuring remission currently in use by clinicians.
The average age of the patients was 46 years, and 80% were female. All had symptoms of early arthritis for more than six weeks but for less than 12 months, and all had two or more swollen joints or one swollen joint in the hand plus one additional symptom of arthritis (e.g., morning stiffness). Fifty-nine percent of patients in the cohort initiated combination DMARD therapy (methotrexate plus another DMARD such as sulfasalazine or hydroxychloroquine); 40 percent started only methotrexate. The methotrexate dose was somewhat higher than usually reached, with 35 percent of patients taking 20 to 25 mg per week. At six and 12 months, 13 percent and 28 percent of the patients had initiated biologic therapy, respectively. By 12 months, only 20% of patients required biologic therapies.
While some remission criteria are more stringent than others, at the end of the 12 month period approximately half of the patients were able to achieve remission as a result of having prompted started an optimal DMARD therapy.
“This study highlights the benefits of early DMARD therapy, ideally in combination, using a higher dose of methotrexate,” said Vivian Bykerk, MD, University of Toronto, and lead investigator in the study. “However further investigations are needed to identify those who will and will not benefit from this initial strategy and those who require a more aggressive treatment strategy.”