Research ArticleArticle
Failure in Longterm Treatment is Rare in Actively Treated Patients with Rheumatoid Arthritis, But May Be Predicted by High Health Assessment Score at Baseline and by Residual Disease Activity at 3 and 6 Months: The 5-year Followup Results of the Randomized Clinical NEO-RACo Trial
Vappu Rantalaiho, Hannu Kautiainen, Salme Järvenpää, Markku Korpela, Timo Malmi, Pekka Hannonen, Oili Kaipiainen-Seppänen, Timo Yli-Kerttula, Timo Möttönen, Anu Mustila, Anna Karjalainen, Leena Paimela, Toini Uutela, Marjatta Leirisalo-Repo and for the NEO-RACo Study Group
The Journal of Rheumatology December 2014, 41 (12) 2379-2385; DOI: https://doi.org/10.3899/jrheum.140267
Vappu Rantalaiho
From the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; Fimlab Laboratories, Tampere; Unit of Primary Health Care; Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital; Department of General Practice; Institute of Clinical Medicine, University of Helsinki; Orton Hospital, Helsinki; Unit of Primary Health Care; Department of Medicine, Kuopio University Hospital, Kuopio; Medcare Foundation, Äänekoski; Department of Medicine, Seinäjoki Central Hospital, Seinäjoki; Department of Medicine, Jyväskylä Central Hospital, Jyväskylä; Department of Rheumatology, Satakunta Central Hospital, Rauma; Division of Medicine and Department of Rheumatology, Turku University Hospital, Turku; Department of Medicine, Oulu University Hospital, Oulu; Central Hospital of Lapland, Rovaniemi,
Finland.V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; H. Kautiainen, Professor of Biostatistics, Unit of Primary Health Care, Helsinki University Central Hospital, Department of General Practice, University of Helsinki, Unit of Primary Health Care, Kuopio University Hospital; S. Järvenpää, Biostatistician, Medcare Foundation; M. Korpela, MD, PhD, Docent, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; T. Malmi, MD, Specialist in Rheumatology, Department of Medicine, Seinäjoki Central Hospital; P. Hannonen, MD, PhD, Professor, Head of Department, Department of Medicine, Jyväskylä Central Hospital; O. Kaipiainen-Seppänen, MD, PhD, Docent, Chief of Division, Department of Medicine, Kuopio University Hospital; T. Yli-Kerttula, MD, PhD, Chief of Division, Department of Rheumatology, Satakunta Central Hospital; T. Möttönen, MD, PhD, Professor, Chief of Division, Division of Medicine, Department of Rheumatology, Turku University Hospital; A. Mustila, MD, PhD, Head of Department, Fimlab Laboratories; A. Karjalainen, MD, PhD, Assistant Chief of Division, Department of Medicine, Oulu University Hospital; L. Paimela, MD, PhD, Rheumatology Consultant, Orton Hospital; T. Uutela, MD, Head of Department, Central Hospital of Lapland; M. Leirisalo-Repo, MD, PhD, Professor, Chief of Division, Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, Institute of Clinical Medicine, University of Helsinki.
Hannu Kautiainen
From the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; Fimlab Laboratories, Tampere; Unit of Primary Health Care; Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital; Department of General Practice; Institute of Clinical Medicine, University of Helsinki; Orton Hospital, Helsinki; Unit of Primary Health Care; Department of Medicine, Kuopio University Hospital, Kuopio; Medcare Foundation, Äänekoski; Department of Medicine, Seinäjoki Central Hospital, Seinäjoki; Department of Medicine, Jyväskylä Central Hospital, Jyväskylä; Department of Rheumatology, Satakunta Central Hospital, Rauma; Division of Medicine and Department of Rheumatology, Turku University Hospital, Turku; Department of Medicine, Oulu University Hospital, Oulu; Central Hospital of Lapland, Rovaniemi,
Finland.V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; H. Kautiainen, Professor of Biostatistics, Unit of Primary Health Care, Helsinki University Central Hospital, Department of General Practice, University of Helsinki, Unit of Primary Health Care, Kuopio University Hospital; S. Järvenpää, Biostatistician, Medcare Foundation; M. Korpela, MD, PhD, Docent, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; T. Malmi, MD, Specialist in Rheumatology, Department of Medicine, Seinäjoki Central Hospital; P. Hannonen, MD, PhD, Professor, Head of Department, Department of Medicine, Jyväskylä Central Hospital; O. Kaipiainen-Seppänen, MD, PhD, Docent, Chief of Division, Department of Medicine, Kuopio University Hospital; T. Yli-Kerttula, MD, PhD, Chief of Division, Department of Rheumatology, Satakunta Central Hospital; T. Möttönen, MD, PhD, Professor, Chief of Division, Division of Medicine, Department of Rheumatology, Turku University Hospital; A. Mustila, MD, PhD, Head of Department, Fimlab Laboratories; A. Karjalainen, MD, PhD, Assistant Chief of Division, Department of Medicine, Oulu University Hospital; L. Paimela, MD, PhD, Rheumatology Consultant, Orton Hospital; T. Uutela, MD, Head of Department, Central Hospital of Lapland; M. Leirisalo-Repo, MD, PhD, Professor, Chief of Division, Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, Institute of Clinical Medicine, University of Helsinki.
Salme Järvenpää
From the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; Fimlab Laboratories, Tampere; Unit of Primary Health Care; Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital; Department of General Practice; Institute of Clinical Medicine, University of Helsinki; Orton Hospital, Helsinki; Unit of Primary Health Care; Department of Medicine, Kuopio University Hospital, Kuopio; Medcare Foundation, Äänekoski; Department of Medicine, Seinäjoki Central Hospital, Seinäjoki; Department of Medicine, Jyväskylä Central Hospital, Jyväskylä; Department of Rheumatology, Satakunta Central Hospital, Rauma; Division of Medicine and Department of Rheumatology, Turku University Hospital, Turku; Department of Medicine, Oulu University Hospital, Oulu; Central Hospital of Lapland, Rovaniemi,
Finland.V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; H. Kautiainen, Professor of Biostatistics, Unit of Primary Health Care, Helsinki University Central Hospital, Department of General Practice, University of Helsinki, Unit of Primary Health Care, Kuopio University Hospital; S. Järvenpää, Biostatistician, Medcare Foundation; M. Korpela, MD, PhD, Docent, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; T. Malmi, MD, Specialist in Rheumatology, Department of Medicine, Seinäjoki Central Hospital; P. Hannonen, MD, PhD, Professor, Head of Department, Department of Medicine, Jyväskylä Central Hospital; O. Kaipiainen-Seppänen, MD, PhD, Docent, Chief of Division, Department of Medicine, Kuopio University Hospital; T. Yli-Kerttula, MD, PhD, Chief of Division, Department of Rheumatology, Satakunta Central Hospital; T. Möttönen, MD, PhD, Professor, Chief of Division, Division of Medicine, Department of Rheumatology, Turku University Hospital; A. Mustila, MD, PhD, Head of Department, Fimlab Laboratories; A. Karjalainen, MD, PhD, Assistant Chief of Division, Department of Medicine, Oulu University Hospital; L. Paimela, MD, PhD, Rheumatology Consultant, Orton Hospital; T. Uutela, MD, Head of Department, Central Hospital of Lapland; M. Leirisalo-Repo, MD, PhD, Professor, Chief of Division, Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, Institute of Clinical Medicine, University of Helsinki.
Markku Korpela
From the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; Fimlab Laboratories, Tampere; Unit of Primary Health Care; Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital; Department of General Practice; Institute of Clinical Medicine, University of Helsinki; Orton Hospital, Helsinki; Unit of Primary Health Care; Department of Medicine, Kuopio University Hospital, Kuopio; Medcare Foundation, Äänekoski; Department of Medicine, Seinäjoki Central Hospital, Seinäjoki; Department of Medicine, Jyväskylä Central Hospital, Jyväskylä; Department of Rheumatology, Satakunta Central Hospital, Rauma; Division of Medicine and Department of Rheumatology, Turku University Hospital, Turku; Department of Medicine, Oulu University Hospital, Oulu; Central Hospital of Lapland, Rovaniemi,
Finland.V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; H. Kautiainen, Professor of Biostatistics, Unit of Primary Health Care, Helsinki University Central Hospital, Department of General Practice, University of Helsinki, Unit of Primary Health Care, Kuopio University Hospital; S. Järvenpää, Biostatistician, Medcare Foundation; M. Korpela, MD, PhD, Docent, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; T. Malmi, MD, Specialist in Rheumatology, Department of Medicine, Seinäjoki Central Hospital; P. Hannonen, MD, PhD, Professor, Head of Department, Department of Medicine, Jyväskylä Central Hospital; O. Kaipiainen-Seppänen, MD, PhD, Docent, Chief of Division, Department of Medicine, Kuopio University Hospital; T. Yli-Kerttula, MD, PhD, Chief of Division, Department of Rheumatology, Satakunta Central Hospital; T. Möttönen, MD, PhD, Professor, Chief of Division, Division of Medicine, Department of Rheumatology, Turku University Hospital; A. Mustila, MD, PhD, Head of Department, Fimlab Laboratories; A. Karjalainen, MD, PhD, Assistant Chief of Division, Department of Medicine, Oulu University Hospital; L. Paimela, MD, PhD, Rheumatology Consultant, Orton Hospital; T. Uutela, MD, Head of Department, Central Hospital of Lapland; M. Leirisalo-Repo, MD, PhD, Professor, Chief of Division, Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, Institute of Clinical Medicine, University of Helsinki.
Timo Malmi
From the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; Fimlab Laboratories, Tampere; Unit of Primary Health Care; Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital; Department of General Practice; Institute of Clinical Medicine, University of Helsinki; Orton Hospital, Helsinki; Unit of Primary Health Care; Department of Medicine, Kuopio University Hospital, Kuopio; Medcare Foundation, Äänekoski; Department of Medicine, Seinäjoki Central Hospital, Seinäjoki; Department of Medicine, Jyväskylä Central Hospital, Jyväskylä; Department of Rheumatology, Satakunta Central Hospital, Rauma; Division of Medicine and Department of Rheumatology, Turku University Hospital, Turku; Department of Medicine, Oulu University Hospital, Oulu; Central Hospital of Lapland, Rovaniemi,
Finland.V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; H. Kautiainen, Professor of Biostatistics, Unit of Primary Health Care, Helsinki University Central Hospital, Department of General Practice, University of Helsinki, Unit of Primary Health Care, Kuopio University Hospital; S. Järvenpää, Biostatistician, Medcare Foundation; M. Korpela, MD, PhD, Docent, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; T. Malmi, MD, Specialist in Rheumatology, Department of Medicine, Seinäjoki Central Hospital; P. Hannonen, MD, PhD, Professor, Head of Department, Department of Medicine, Jyväskylä Central Hospital; O. Kaipiainen-Seppänen, MD, PhD, Docent, Chief of Division, Department of Medicine, Kuopio University Hospital; T. Yli-Kerttula, MD, PhD, Chief of Division, Department of Rheumatology, Satakunta Central Hospital; T. Möttönen, MD, PhD, Professor, Chief of Division, Division of Medicine, Department of Rheumatology, Turku University Hospital; A. Mustila, MD, PhD, Head of Department, Fimlab Laboratories; A. Karjalainen, MD, PhD, Assistant Chief of Division, Department of Medicine, Oulu University Hospital; L. Paimela, MD, PhD, Rheumatology Consultant, Orton Hospital; T. Uutela, MD, Head of Department, Central Hospital of Lapland; M. Leirisalo-Repo, MD, PhD, Professor, Chief of Division, Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, Institute of Clinical Medicine, University of Helsinki.
Pekka Hannonen
From the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; Fimlab Laboratories, Tampere; Unit of Primary Health Care; Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital; Department of General Practice; Institute of Clinical Medicine, University of Helsinki; Orton Hospital, Helsinki; Unit of Primary Health Care; Department of Medicine, Kuopio University Hospital, Kuopio; Medcare Foundation, Äänekoski; Department of Medicine, Seinäjoki Central Hospital, Seinäjoki; Department of Medicine, Jyväskylä Central Hospital, Jyväskylä; Department of Rheumatology, Satakunta Central Hospital, Rauma; Division of Medicine and Department of Rheumatology, Turku University Hospital, Turku; Department of Medicine, Oulu University Hospital, Oulu; Central Hospital of Lapland, Rovaniemi,
Finland.V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; H. Kautiainen, Professor of Biostatistics, Unit of Primary Health Care, Helsinki University Central Hospital, Department of General Practice, University of Helsinki, Unit of Primary Health Care, Kuopio University Hospital; S. Järvenpää, Biostatistician, Medcare Foundation; M. Korpela, MD, PhD, Docent, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; T. Malmi, MD, Specialist in Rheumatology, Department of Medicine, Seinäjoki Central Hospital; P. Hannonen, MD, PhD, Professor, Head of Department, Department of Medicine, Jyväskylä Central Hospital; O. Kaipiainen-Seppänen, MD, PhD, Docent, Chief of Division, Department of Medicine, Kuopio University Hospital; T. Yli-Kerttula, MD, PhD, Chief of Division, Department of Rheumatology, Satakunta Central Hospital; T. Möttönen, MD, PhD, Professor, Chief of Division, Division of Medicine, Department of Rheumatology, Turku University Hospital; A. Mustila, MD, PhD, Head of Department, Fimlab Laboratories; A. Karjalainen, MD, PhD, Assistant Chief of Division, Department of Medicine, Oulu University Hospital; L. Paimela, MD, PhD, Rheumatology Consultant, Orton Hospital; T. Uutela, MD, Head of Department, Central Hospital of Lapland; M. Leirisalo-Repo, MD, PhD, Professor, Chief of Division, Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, Institute of Clinical Medicine, University of Helsinki.
Oili Kaipiainen-Seppänen
From the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; Fimlab Laboratories, Tampere; Unit of Primary Health Care; Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital; Department of General Practice; Institute of Clinical Medicine, University of Helsinki; Orton Hospital, Helsinki; Unit of Primary Health Care; Department of Medicine, Kuopio University Hospital, Kuopio; Medcare Foundation, Äänekoski; Department of Medicine, Seinäjoki Central Hospital, Seinäjoki; Department of Medicine, Jyväskylä Central Hospital, Jyväskylä; Department of Rheumatology, Satakunta Central Hospital, Rauma; Division of Medicine and Department of Rheumatology, Turku University Hospital, Turku; Department of Medicine, Oulu University Hospital, Oulu; Central Hospital of Lapland, Rovaniemi,
Finland.V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; H. Kautiainen, Professor of Biostatistics, Unit of Primary Health Care, Helsinki University Central Hospital, Department of General Practice, University of Helsinki, Unit of Primary Health Care, Kuopio University Hospital; S. Järvenpää, Biostatistician, Medcare Foundation; M. Korpela, MD, PhD, Docent, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; T. Malmi, MD, Specialist in Rheumatology, Department of Medicine, Seinäjoki Central Hospital; P. Hannonen, MD, PhD, Professor, Head of Department, Department of Medicine, Jyväskylä Central Hospital; O. Kaipiainen-Seppänen, MD, PhD, Docent, Chief of Division, Department of Medicine, Kuopio University Hospital; T. Yli-Kerttula, MD, PhD, Chief of Division, Department of Rheumatology, Satakunta Central Hospital; T. Möttönen, MD, PhD, Professor, Chief of Division, Division of Medicine, Department of Rheumatology, Turku University Hospital; A. Mustila, MD, PhD, Head of Department, Fimlab Laboratories; A. Karjalainen, MD, PhD, Assistant Chief of Division, Department of Medicine, Oulu University Hospital; L. Paimela, MD, PhD, Rheumatology Consultant, Orton Hospital; T. Uutela, MD, Head of Department, Central Hospital of Lapland; M. Leirisalo-Repo, MD, PhD, Professor, Chief of Division, Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, Institute of Clinical Medicine, University of Helsinki.
Timo Yli-Kerttula
From the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; Fimlab Laboratories, Tampere; Unit of Primary Health Care; Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital; Department of General Practice; Institute of Clinical Medicine, University of Helsinki; Orton Hospital, Helsinki; Unit of Primary Health Care; Department of Medicine, Kuopio University Hospital, Kuopio; Medcare Foundation, Äänekoski; Department of Medicine, Seinäjoki Central Hospital, Seinäjoki; Department of Medicine, Jyväskylä Central Hospital, Jyväskylä; Department of Rheumatology, Satakunta Central Hospital, Rauma; Division of Medicine and Department of Rheumatology, Turku University Hospital, Turku; Department of Medicine, Oulu University Hospital, Oulu; Central Hospital of Lapland, Rovaniemi,
Finland.V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; H. Kautiainen, Professor of Biostatistics, Unit of Primary Health Care, Helsinki University Central Hospital, Department of General Practice, University of Helsinki, Unit of Primary Health Care, Kuopio University Hospital; S. Järvenpää, Biostatistician, Medcare Foundation; M. Korpela, MD, PhD, Docent, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; T. Malmi, MD, Specialist in Rheumatology, Department of Medicine, Seinäjoki Central Hospital; P. Hannonen, MD, PhD, Professor, Head of Department, Department of Medicine, Jyväskylä Central Hospital; O. Kaipiainen-Seppänen, MD, PhD, Docent, Chief of Division, Department of Medicine, Kuopio University Hospital; T. Yli-Kerttula, MD, PhD, Chief of Division, Department of Rheumatology, Satakunta Central Hospital; T. Möttönen, MD, PhD, Professor, Chief of Division, Division of Medicine, Department of Rheumatology, Turku University Hospital; A. Mustila, MD, PhD, Head of Department, Fimlab Laboratories; A. Karjalainen, MD, PhD, Assistant Chief of Division, Department of Medicine, Oulu University Hospital; L. Paimela, MD, PhD, Rheumatology Consultant, Orton Hospital; T. Uutela, MD, Head of Department, Central Hospital of Lapland; M. Leirisalo-Repo, MD, PhD, Professor, Chief of Division, Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, Institute of Clinical Medicine, University of Helsinki.
Timo Möttönen
From the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; Fimlab Laboratories, Tampere; Unit of Primary Health Care; Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital; Department of General Practice; Institute of Clinical Medicine, University of Helsinki; Orton Hospital, Helsinki; Unit of Primary Health Care; Department of Medicine, Kuopio University Hospital, Kuopio; Medcare Foundation, Äänekoski; Department of Medicine, Seinäjoki Central Hospital, Seinäjoki; Department of Medicine, Jyväskylä Central Hospital, Jyväskylä; Department of Rheumatology, Satakunta Central Hospital, Rauma; Division of Medicine and Department of Rheumatology, Turku University Hospital, Turku; Department of Medicine, Oulu University Hospital, Oulu; Central Hospital of Lapland, Rovaniemi,
Finland.V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; H. Kautiainen, Professor of Biostatistics, Unit of Primary Health Care, Helsinki University Central Hospital, Department of General Practice, University of Helsinki, Unit of Primary Health Care, Kuopio University Hospital; S. Järvenpää, Biostatistician, Medcare Foundation; M. Korpela, MD, PhD, Docent, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; T. Malmi, MD, Specialist in Rheumatology, Department of Medicine, Seinäjoki Central Hospital; P. Hannonen, MD, PhD, Professor, Head of Department, Department of Medicine, Jyväskylä Central Hospital; O. Kaipiainen-Seppänen, MD, PhD, Docent, Chief of Division, Department of Medicine, Kuopio University Hospital; T. Yli-Kerttula, MD, PhD, Chief of Division, Department of Rheumatology, Satakunta Central Hospital; T. Möttönen, MD, PhD, Professor, Chief of Division, Division of Medicine, Department of Rheumatology, Turku University Hospital; A. Mustila, MD, PhD, Head of Department, Fimlab Laboratories; A. Karjalainen, MD, PhD, Assistant Chief of Division, Department of Medicine, Oulu University Hospital; L. Paimela, MD, PhD, Rheumatology Consultant, Orton Hospital; T. Uutela, MD, Head of Department, Central Hospital of Lapland; M. Leirisalo-Repo, MD, PhD, Professor, Chief of Division, Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, Institute of Clinical Medicine, University of Helsinki.
Anu Mustila
From the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; Fimlab Laboratories, Tampere; Unit of Primary Health Care; Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital; Department of General Practice; Institute of Clinical Medicine, University of Helsinki; Orton Hospital, Helsinki; Unit of Primary Health Care; Department of Medicine, Kuopio University Hospital, Kuopio; Medcare Foundation, Äänekoski; Department of Medicine, Seinäjoki Central Hospital, Seinäjoki; Department of Medicine, Jyväskylä Central Hospital, Jyväskylä; Department of Rheumatology, Satakunta Central Hospital, Rauma; Division of Medicine and Department of Rheumatology, Turku University Hospital, Turku; Department of Medicine, Oulu University Hospital, Oulu; Central Hospital of Lapland, Rovaniemi,
Finland.V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; H. Kautiainen, Professor of Biostatistics, Unit of Primary Health Care, Helsinki University Central Hospital, Department of General Practice, University of Helsinki, Unit of Primary Health Care, Kuopio University Hospital; S. Järvenpää, Biostatistician, Medcare Foundation; M. Korpela, MD, PhD, Docent, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; T. Malmi, MD, Specialist in Rheumatology, Department of Medicine, Seinäjoki Central Hospital; P. Hannonen, MD, PhD, Professor, Head of Department, Department of Medicine, Jyväskylä Central Hospital; O. Kaipiainen-Seppänen, MD, PhD, Docent, Chief of Division, Department of Medicine, Kuopio University Hospital; T. Yli-Kerttula, MD, PhD, Chief of Division, Department of Rheumatology, Satakunta Central Hospital; T. Möttönen, MD, PhD, Professor, Chief of Division, Division of Medicine, Department of Rheumatology, Turku University Hospital; A. Mustila, MD, PhD, Head of Department, Fimlab Laboratories; A. Karjalainen, MD, PhD, Assistant Chief of Division, Department of Medicine, Oulu University Hospital; L. Paimela, MD, PhD, Rheumatology Consultant, Orton Hospital; T. Uutela, MD, Head of Department, Central Hospital of Lapland; M. Leirisalo-Repo, MD, PhD, Professor, Chief of Division, Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, Institute of Clinical Medicine, University of Helsinki.
Anna Karjalainen
From the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; Fimlab Laboratories, Tampere; Unit of Primary Health Care; Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital; Department of General Practice; Institute of Clinical Medicine, University of Helsinki; Orton Hospital, Helsinki; Unit of Primary Health Care; Department of Medicine, Kuopio University Hospital, Kuopio; Medcare Foundation, Äänekoski; Department of Medicine, Seinäjoki Central Hospital, Seinäjoki; Department of Medicine, Jyväskylä Central Hospital, Jyväskylä; Department of Rheumatology, Satakunta Central Hospital, Rauma; Division of Medicine and Department of Rheumatology, Turku University Hospital, Turku; Department of Medicine, Oulu University Hospital, Oulu; Central Hospital of Lapland, Rovaniemi,
Finland.V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; H. Kautiainen, Professor of Biostatistics, Unit of Primary Health Care, Helsinki University Central Hospital, Department of General Practice, University of Helsinki, Unit of Primary Health Care, Kuopio University Hospital; S. Järvenpää, Biostatistician, Medcare Foundation; M. Korpela, MD, PhD, Docent, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; T. Malmi, MD, Specialist in Rheumatology, Department of Medicine, Seinäjoki Central Hospital; P. Hannonen, MD, PhD, Professor, Head of Department, Department of Medicine, Jyväskylä Central Hospital; O. Kaipiainen-Seppänen, MD, PhD, Docent, Chief of Division, Department of Medicine, Kuopio University Hospital; T. Yli-Kerttula, MD, PhD, Chief of Division, Department of Rheumatology, Satakunta Central Hospital; T. Möttönen, MD, PhD, Professor, Chief of Division, Division of Medicine, Department of Rheumatology, Turku University Hospital; A. Mustila, MD, PhD, Head of Department, Fimlab Laboratories; A. Karjalainen, MD, PhD, Assistant Chief of Division, Department of Medicine, Oulu University Hospital; L. Paimela, MD, PhD, Rheumatology Consultant, Orton Hospital; T. Uutela, MD, Head of Department, Central Hospital of Lapland; M. Leirisalo-Repo, MD, PhD, Professor, Chief of Division, Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, Institute of Clinical Medicine, University of Helsinki.
Leena Paimela
From the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; Fimlab Laboratories, Tampere; Unit of Primary Health Care; Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital; Department of General Practice; Institute of Clinical Medicine, University of Helsinki; Orton Hospital, Helsinki; Unit of Primary Health Care; Department of Medicine, Kuopio University Hospital, Kuopio; Medcare Foundation, Äänekoski; Department of Medicine, Seinäjoki Central Hospital, Seinäjoki; Department of Medicine, Jyväskylä Central Hospital, Jyväskylä; Department of Rheumatology, Satakunta Central Hospital, Rauma; Division of Medicine and Department of Rheumatology, Turku University Hospital, Turku; Department of Medicine, Oulu University Hospital, Oulu; Central Hospital of Lapland, Rovaniemi,
Finland.V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; H. Kautiainen, Professor of Biostatistics, Unit of Primary Health Care, Helsinki University Central Hospital, Department of General Practice, University of Helsinki, Unit of Primary Health Care, Kuopio University Hospital; S. Järvenpää, Biostatistician, Medcare Foundation; M. Korpela, MD, PhD, Docent, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; T. Malmi, MD, Specialist in Rheumatology, Department of Medicine, Seinäjoki Central Hospital; P. Hannonen, MD, PhD, Professor, Head of Department, Department of Medicine, Jyväskylä Central Hospital; O. Kaipiainen-Seppänen, MD, PhD, Docent, Chief of Division, Department of Medicine, Kuopio University Hospital; T. Yli-Kerttula, MD, PhD, Chief of Division, Department of Rheumatology, Satakunta Central Hospital; T. Möttönen, MD, PhD, Professor, Chief of Division, Division of Medicine, Department of Rheumatology, Turku University Hospital; A. Mustila, MD, PhD, Head of Department, Fimlab Laboratories; A. Karjalainen, MD, PhD, Assistant Chief of Division, Department of Medicine, Oulu University Hospital; L. Paimela, MD, PhD, Rheumatology Consultant, Orton Hospital; T. Uutela, MD, Head of Department, Central Hospital of Lapland; M. Leirisalo-Repo, MD, PhD, Professor, Chief of Division, Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, Institute of Clinical Medicine, University of Helsinki.
Toini Uutela
From the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; Fimlab Laboratories, Tampere; Unit of Primary Health Care; Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital; Department of General Practice; Institute of Clinical Medicine, University of Helsinki; Orton Hospital, Helsinki; Unit of Primary Health Care; Department of Medicine, Kuopio University Hospital, Kuopio; Medcare Foundation, Äänekoski; Department of Medicine, Seinäjoki Central Hospital, Seinäjoki; Department of Medicine, Jyväskylä Central Hospital, Jyväskylä; Department of Rheumatology, Satakunta Central Hospital, Rauma; Division of Medicine and Department of Rheumatology, Turku University Hospital, Turku; Department of Medicine, Oulu University Hospital, Oulu; Central Hospital of Lapland, Rovaniemi,
Finland.V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; H. Kautiainen, Professor of Biostatistics, Unit of Primary Health Care, Helsinki University Central Hospital, Department of General Practice, University of Helsinki, Unit of Primary Health Care, Kuopio University Hospital; S. Järvenpää, Biostatistician, Medcare Foundation; M. Korpela, MD, PhD, Docent, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; T. Malmi, MD, Specialist in Rheumatology, Department of Medicine, Seinäjoki Central Hospital; P. Hannonen, MD, PhD, Professor, Head of Department, Department of Medicine, Jyväskylä Central Hospital; O. Kaipiainen-Seppänen, MD, PhD, Docent, Chief of Division, Department of Medicine, Kuopio University Hospital; T. Yli-Kerttula, MD, PhD, Chief of Division, Department of Rheumatology, Satakunta Central Hospital; T. Möttönen, MD, PhD, Professor, Chief of Division, Division of Medicine, Department of Rheumatology, Turku University Hospital; A. Mustila, MD, PhD, Head of Department, Fimlab Laboratories; A. Karjalainen, MD, PhD, Assistant Chief of Division, Department of Medicine, Oulu University Hospital; L. Paimela, MD, PhD, Rheumatology Consultant, Orton Hospital; T. Uutela, MD, Head of Department, Central Hospital of Lapland; M. Leirisalo-Repo, MD, PhD, Professor, Chief of Division, Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, Institute of Clinical Medicine, University of Helsinki.
Marjatta Leirisalo-Repo
From the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; Fimlab Laboratories, Tampere; Unit of Primary Health Care; Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital; Department of General Practice; Institute of Clinical Medicine, University of Helsinki; Orton Hospital, Helsinki; Unit of Primary Health Care; Department of Medicine, Kuopio University Hospital, Kuopio; Medcare Foundation, Äänekoski; Department of Medicine, Seinäjoki Central Hospital, Seinäjoki; Department of Medicine, Jyväskylä Central Hospital, Jyväskylä; Department of Rheumatology, Satakunta Central Hospital, Rauma; Division of Medicine and Department of Rheumatology, Turku University Hospital, Turku; Department of Medicine, Oulu University Hospital, Oulu; Central Hospital of Lapland, Rovaniemi,
Finland.V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; H. Kautiainen, Professor of Biostatistics, Unit of Primary Health Care, Helsinki University Central Hospital, Department of General Practice, University of Helsinki, Unit of Primary Health Care, Kuopio University Hospital; S. Järvenpää, Biostatistician, Medcare Foundation; M. Korpela, MD, PhD, Docent, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; T. Malmi, MD, Specialist in Rheumatology, Department of Medicine, Seinäjoki Central Hospital; P. Hannonen, MD, PhD, Professor, Head of Department, Department of Medicine, Jyväskylä Central Hospital; O. Kaipiainen-Seppänen, MD, PhD, Docent, Chief of Division, Department of Medicine, Kuopio University Hospital; T. Yli-Kerttula, MD, PhD, Chief of Division, Department of Rheumatology, Satakunta Central Hospital; T. Möttönen, MD, PhD, Professor, Chief of Division, Division of Medicine, Department of Rheumatology, Turku University Hospital; A. Mustila, MD, PhD, Head of Department, Fimlab Laboratories; A. Karjalainen, MD, PhD, Assistant Chief of Division, Department of Medicine, Oulu University Hospital; L. Paimela, MD, PhD, Rheumatology Consultant, Orton Hospital; T. Uutela, MD, Head of Department, Central Hospital of Lapland; M. Leirisalo-Repo, MD, PhD, Professor, Chief of Division, Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, Institute of Clinical Medicine, University of Helsinki.
From the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; Fimlab Laboratories, Tampere; Unit of Primary Health Care; Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital; Department of General Practice; Institute of Clinical Medicine, University of Helsinki; Orton Hospital, Helsinki; Unit of Primary Health Care; Department of Medicine, Kuopio University Hospital, Kuopio; Medcare Foundation, Äänekoski; Department of Medicine, Seinäjoki Central Hospital, Seinäjoki; Department of Medicine, Jyväskylä Central Hospital, Jyväskylä; Department of Rheumatology, Satakunta Central Hospital, Rauma; Division of Medicine and Department of Rheumatology, Turku University Hospital, Turku; Department of Medicine, Oulu University Hospital, Oulu; Central Hospital of Lapland, Rovaniemi,
Finland.V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; H. Kautiainen, Professor of Biostatistics, Unit of Primary Health Care, Helsinki University Central Hospital, Department of General Practice, University of Helsinki, Unit of Primary Health Care, Kuopio University Hospital; S. Järvenpää, Biostatistician, Medcare Foundation; M. Korpela, MD, PhD, Docent, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; T. Malmi, MD, Specialist in Rheumatology, Department of Medicine, Seinäjoki Central Hospital; P. Hannonen, MD, PhD, Professor, Head of Department, Department of Medicine, Jyväskylä Central Hospital; O. Kaipiainen-Seppänen, MD, PhD, Docent, Chief of Division, Department of Medicine, Kuopio University Hospital; T. Yli-Kerttula, MD, PhD, Chief of Division, Department of Rheumatology, Satakunta Central Hospital; T. Möttönen, MD, PhD, Professor, Chief of Division, Division of Medicine, Department of Rheumatology, Turku University Hospital; A. Mustila, MD, PhD, Head of Department, Fimlab Laboratories; A. Karjalainen, MD, PhD, Assistant Chief of Division, Department of Medicine, Oulu University Hospital; L. Paimela, MD, PhD, Rheumatology Consultant, Orton Hospital; T. Uutela, MD, Head of Department, Central Hospital of Lapland; M. Leirisalo-Repo, MD, PhD, Professor, Chief of Division, Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, Institute of Clinical Medicine, University of Helsinki.
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Abstract
Objective. With modern initial aggressive combination treatments with synthetic disease-modifying antirheumatic drugs (sDMARD), most patients with rheumatoid arthritis (RA) achieve remission, have marginal radiographic progression, and sustain normal function. Here we aim to identify the patients failing these targets even after aggressive treatment.
Methods. Ninety-nine patients with early, active RA were treated with a combination of 3 sDMARD and prednisolone (PRD), and either infliximab or placebo infusions during the first 6 months, aiming at strict remission. After 24 months, the treatments became unrestricted. At 60 months, 4 evident clinical features of treatment failure were defined: area under curve (AUC) between 6–60 months for disease activity score assessing 28 joints > 2.6; AUC 6–60 for health assessment questionnaire > 0.5; progression in total Sharp/van der Heijde score 0–60 months > 3 units; and need of PRD or biologic DMARD treatment at 60 months.
Results. A total of 93 patients were followed up for 60 months. Of them, 45 had no features of treatment failure, 30 had 1, 10 had 2, 7 had 3, and 1 patient had all 4 features. Having 2–4 features of treatment failure at 5 years was predicted by the health assessment score at baseline, and by even low residual disease activity at 3 and 6 months.
Conclusions. Only 20% of the patients with RA treated early with combination sDMARD and PRD have more than 1 clinical feature of treatment failure at 60 months. Residual clinical disease activity at 3–6 months was the most important predictor for identifying these patients. The study was registered at www.clintrials.gov (NCT00908089).
Footnotes
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Supported by the Competitive Research Funding of the Tampere University Hospital (Grants 9M124 and 9M128), the Helsinki University Central Hospital Research Funds, and Finska Läkaresällskapet. V. Rantalaiho has received a personal grant from the Orion-Farmos Research Foundation. At baseline, an unrestricted grant was provided by Schering-Plough Finland, which was used for the purchase of infliximab.
- Accepted for publication August 1, 2014.
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In this issue
The Journal of Rheumatology
Vol. 41, Issue 12
1 Dec 2014
Failure in Longterm Treatment is Rare in Actively Treated Patients with Rheumatoid Arthritis, But May Be Predicted by High Health Assessment Score at Baseline and by Residual Disease Activity at 3 and 6 Months: The 5-year Followup Results of the Randomized Clinical NEO-RACo Trial
Vappu Rantalaiho, Hannu Kautiainen, Salme Järvenpää, Markku Korpela, Timo Malmi, Pekka Hannonen, Oili Kaipiainen-Seppänen, Timo Yli-Kerttula, Timo Möttönen, Anu Mustila, Anna Karjalainen, Leena Paimela, Toini Uutela, Marjatta Leirisalo-Repo, for the NEO-RACo Study Group
The Journal of Rheumatology Dec 2014, 41 (12) 2379-2385; DOI: 10.3899/jrheum.140267
Failure in Longterm Treatment is Rare in Actively Treated Patients with Rheumatoid Arthritis, But May Be Predicted by High Health Assessment Score at Baseline and by Residual Disease Activity at 3 and 6 Months: The 5-year Followup Results of the Randomized Clinical NEO-RACo Trial
Vappu Rantalaiho, Hannu Kautiainen, Salme Järvenpää, Markku Korpela, Timo Malmi, Pekka Hannonen, Oili Kaipiainen-Seppänen, Timo Yli-Kerttula, Timo Möttönen, Anu Mustila, Anna Karjalainen, Leena Paimela, Toini Uutela, Marjatta Leirisalo-Repo, for the NEO-RACo Study Group
The Journal of Rheumatology Dec 2014, 41 (12) 2379-2385; DOI: 10.3899/jrheum.140267
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