RT Journal Article
SR Electronic
T1 Equivalent Responses to Disease-modifying Antirheumatic Drugs Initiated at Any Time During the First 15 Months After Symptom Onset in Patients with Seropositive Rheumatoid Arthritis
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.090818
DO 10.3899/jrheum.090818
A1 Haoling H. Weng
A1 Veena K. Ranganath
A1 Dinesh Khanna
A1 Myungshin Oh
A1 Daniel E. Furst
A1 Grace S. Park
A1 David A. Elashoff
A1 John T. Sharp
A1 Richard H. Gold
A1 James B. Peter
A1 Harold E. Paulus
A1 the Western Consortium of Practicing Rheumatologists
YR 2010
UL http://www.jrheum.org/content/early/2010/01/27/jrheum.090818.abstract
AB Objective To evaluate responses by time to initiation of nonbiologic disease-modifying antirheumatic drugs (DMARD) in a DMARD-naive cohort of patients with early seropositive rheumatoid arthritis (RA). Methods Subjects were categorized by the time from symptom onset to the first DMARD use (median 5.7 months, range 0.6–15.9). Subjects who started their first DMARD within 5 months of symptom onset were compared to subjects who started after 5 months. Disease Activity Scores (DAS-44) and total Sharp Score (TSS) progression rates were analyzed using Wilcoxon rank-sum and chi-square tests; multiple linear regression analysis adjusted for potential covariates. The slope of the least-squares regression line was calculated to estimate the annualized TSS progression rates. Results Of 233 RA patients, 76% were female and mean age was 50 (SD 13) years. At DMARD start, DAS-44 was similar in all subsets within the 0.6 to 15 months’ duration between symptom onset and DMARD initiation. Erosion scores tended to be higher in those who started DMARD later, but Health Assessment Questionnaire-Disability Index (HAQ-DI) scores were higher in those who started DMARD earlier. During the 2 years after DMARD initiation, improvements in HAQ-DI and DAS-44 were similar in the various duration subsets, with about 25% ever achieving DAS remission (DAS < 1.6). Radiographic progression tended to be numerically but not statistically more rapid in the earlier subsets. Conclusion Following initiation of nonbiologic DMARD therapy at various times within 15 months of symptom onset, improvements of DAS-44, HAQ-DI, remission rate, and radiographic progression rate were similar, although higher baseline erosion scores were present in those with later initiation of DMARD.