Early Aggressive Treatment for RA May Mean Better Outcomes

Newswise — People with early stage rheumatoid arthritis should receive aggressive care, including monthly outpatient assessments and escalated therapy based on disease activity, in order to achieve better outcomes, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Orlando, Florida.

A cohort of 110 patients with active rheumatoid arthritis who had the disease for less than five years were randomized to receive routine outpatient care or intensive outpatient care, and followed for 18 months. Routine outpatient care was delivered in the rheumatology clinics of two teaching hospitals in Glasgow, Scotland. Intensive care consisted of monthly outpatient assessments with careful measurement of the activity of the arthritis, joint injections of corticosteroids, and the targeting of persistent disease activity using a protocol to escalate disease-modifying antirheumatic drug, or DMARD, therapy including methotrexate, cyclosporine, and sulfasalazine, in patients with persistent disease activity. Results showed that 67% of patients in the intensive group achieved very marked improvement in their arthritis at 18 months as measured by standard criteria of disease activity developed by the American College of Rheumatology (ACR 20, 50, 70), compared to 18% of patients in the routine outpatient care group. In addition, patients in the intensive outpatient group demonstrated improved physical function and quality of life, and had less joint damage as assessed by radiographs.

"Rheumatoid arthritis is a severe disease that results in pain, disability and a reduction in quality of life," said Duncan R. Porter, MD, Consultant Rheumatologist, Gartnavel General Hospital, Glasgow, United Kingdom, and an investigator in the study. "This study shows that patients need to be treated intensively, and that persistent disease activity must be targeted by escalating therapy in an attempt to control the disease in the early years. If this is done, patients' symptoms, physical function and quality of life all improve very substantially."

The American College of Rheumatology is the professional organization for rheumatologists and health professionals who share a dedication to healing, preventing disability and curing arthritis and related rheumatic and musculoskeletal diseases. For more information on the ACR's annual meeting, see http://www.rheumatology.org/annual.