TY - JOUR T1 - 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 JF - The Journal of Rheumatology JO - J Rheumatol DO - 10.3899/jrheum.140267 SP - jrheum.140267 AU - Vappu Rantalaiho AU - Hannu Kautiainen AU - Salme Järvenpää AU - Markku Korpela AU - Timo Malmi AU - Pekka Hannonen AU - Oili Kaipiainen-Seppänen AU - Timo Yli-Kerttula AU - Timo Möttönen AU - Anu Mustila AU - Anna Karjalainen AU - Leena Paimela AU - Toini Uutela AU - Marjatta Leirisalo-Repo Y1 - 2014/10/01 UR - http://www.jrheum.org/content/early/2014/09/25/jrheum.140267.abstract N2 - 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. Conclusion 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). ER -