Sustained Remission using Combination DMARDS in RA | Arthritis Information

From the Journal of Rheumatology:

Sustained Remission and Reduced Radiographic Progression with Combination Disease Modifying Antirheumatic Drugs in Early Rheumatoid Arthritis

HEIDI MÄKINEN, HANNU KAUTIAINEN, PEKKA HANNONEN, TIMO MÖTTÖNEN, MARJATTA LEIRISALO-REPO, LEENA LAASONEN, MARKKU KORPELA, HARRI BLÅFIELD, MIKKO HAKOLA, and TUULIKKI SOKKA

ABSTRACT.

Objective. To study sustainability of remission and good treatment response, and the association of both with radiographic progression, in early rheumatoid arthritis (RA) in the Finnish Rheumatoid Arthritis Combination Therapy trial (FIN-RACo).

Methods. Patients were randomized to receive either a combination of disease modifying antirheumatic drugs (DMARD; COMBI, n = 97) or a single DMARD (SINGLE, n = 98). Remission was defined according to modified American College of Rheumatology (ACR) remission criteria and Disease Activity Score 28 joint count (DAS28) < 2.6, and sustained remission as presence of remission at 6, 12, and 24 months. Good treatment response was defined as DAS28 ≤ 3.2 and decrease of DAS28 > 1.2.

Results. In 169 patients with complete data, 33 (42%) COMBI and 18 (20%) SINGLE patients achieved modified ACR remission at 2 years, which was sustained in 11 (14%) COMBI and 3 (3%) SINGLE patients. Fifty-four (68%) COMBI and 37 (41%) SINGLE patients were in DAS28 remission at 2 years, which was sustained in 40 (51%) COMBI and 14 (16%) SINGLE patients. Good treatment response was sustained in 67% of COMBI and 27% of SINGLE patients. Over 2 years, the Larsen score increased by a median of 1 (95% CI 0–2) in patients in sustained DAS28 remission compared to 4 (95% CI 2–16) in patients who were in DAS28 remission at 6 months but lost it later; and by 6 (95% CI 2–10) in patients who were not in remission at 6 months.

Conclusion. A remarkable proportion of patients with early RA treated with combinations of DMARD were in remission at 2 years, and remission was more often sustained compared to patients treated with a single DMARD. Sustained remission protects against radiographic joint damage. (First Release Dec 15 2006; J Rheumatol 2007;34:316–21)

Lynn I think it's thought by Many Dr's now that aggresive treatment early is best. When I first got RA they did not go that route.. [QUOTE=6t5frlane]Lynn I think it's thought by Many Dr's now that aggresive treatment early is best. When I first got RA they did not go that route.. [/QUOTE]

I think you are right. If you talk to the people who were diagnosed before they started to treat RA aggressively, a lot of their stories are heartbreaking.

The amount of damage that they suffered and the health problems that occured during that time really make you appreciate the newer meds/aggressive treatment plans!

9 years after my initial diagnosis I finally achieved clinical remission. I'm going on my second year of CR. It was achieved by using a combo of dmards and a tnf. When I achieved CR I was moderate to severe and had been at that level for at least 5 years with multiple areas of damage and complications. I beat the odds through having no fear of the drugs available, an aggressive RD, and at my age what do I have to lose?

Most of you are much younger than I am and haven't yet developed complications from RA.

When you say that you don't fear the disease or that you don't know anyone who has complications I suggest that you talk to the older population who have had less control and less options for medications.

I have absolutely no idea of how dmards and tnfs will affect my 64 year old body in the future but right now I can do more than I've been able to do in the last 10 years and to me that's remarkable. I wouldn't trade the last 15 months for anything.

I keep posting, not because I have pain or inflammation or need help, but to keep hope alive on the board that it's possible to achieve clinical remission no matter what stage of the disease process or your age. Lindy

Thanks for continuing to post, LinB.

I absolutely need to take DMARDS soon, actually I was given a prescription for a low dose of MTX a few months ago, which I haven't started yet. I've had RA 1-1/2 years, and have no damage YET, but realize it can start at any time and it moves quickly. I was 55 when diagnosed, at a later age, like yourself. My RD thinks that my RA "acts" like palindromic, but because I have low positive RF and anti-CCP, it will become full blown in just a matter of time. She says it's a mild case right now.

Was yours mild at first, and is that why you didn't take DMARDS early on?

Hi Nancy, I had RA symptoms for ten years before I was diagnosed but my labs were normal and I was told by several RDs and Stanford University arthritis clinic that I didn't have RA. Ten years later I was hit with a severe onset of RA with an RF of 972, high sed rate. I was confined to the house because I could barely walk. I started AP with no response, MXT with no response and was put on Pred. until they could figure out what to do. I slowly got better and could function. I tapered off Pred. and did well for 5 years until the flare from hell hit, that's when I decided I needed to take this disease seriously. I went on dmards, tnf, Pred., anti-inflamm., etc. It took 4 years to reach clnical remission. That's the short version.

How do you know that you have no damage? Have you had xrays or scans recently? How about a bone scan for osteo? The 5 years when I felt better was the time that I developed the most damage. I still had active disease and it damaged my fingers, wrist, knees, and ankles. You're two years into the disease and you don't want to wait until you're severe before you start dmards. Take care and let us know how you're doing. Lindy

I had a DX even though I am sero negative within 1 month. I was put on MTX and prednisone and by 3 months I was in a remission that lasted nearly a year. I am in a flare now and I'm not sure what my blood markers will be next week but I feel like I'm out of remission.

Initially my RD wanted me to take a TNF blocker with my MTX but as I stayed in remission he changed his mind.

Thank you for your reply, Lindy.

I had Xrays on hands and shoulders a few months ago but never CTs or MRIs. RD saw no sign if damage then. Also, I've had normal sed rates and CRPs lately. I feel there may be a bit of damage in my shoulders that's not showing on xray -- range of motion is limited in left arm, getting harder to lift overhead.

But otherwise I feel okay. The flares come and go quickly, always asymmetrical, no a.m. stiffness, and not often tired. But (and this should be my tip-off) I've recently had to quit Curves. I'd been going every day after work since being diagnosed, and now it's just too painful to do the arm exercises. But I still walk briskly, 40 minutes each day at lunchtime.

I think I am in denial, and afraid of drug side effects. Never did like taking ANY medication, actually, I have a weird phobia about it! I guess it's easier to ignore RA when the pain isn't constant and I'm feeling normal, as though I do not have a serious illness. But you had damage done while you were feeling fine, and that really hits home. I need to re-evaluate this whole thing. Thank you for your input.

Nancy

Curves did me in. I went one time, did the full rotation and the next day I was in bed and not able to move. It started a flare and really hit me hard. I have to laugh about it now because I was so determined to keep up with my friend and do each and every exercise, well......lesson learned. Take care and I hope that you re-evaluate. Talk further with your RD. Lindy
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