Response-Driven Combination Therapy with Conventional Disease-Modifying Antirheumatic Drugs Can Achieve High Response Rates in Early Rheumatoid Arthritis with Minimal Glucocorticoid and Nonsteroidal Anti-Inflammatory Drug Use
Section snippets
Inducement of Early Referrals
Correspondence and newsletters were sent to family physicians in the practice area to encourage early referral of patients with recent-onset polyarthritis.
Subjects
Consecutive patients presenting between September 1998 and February 2002 with recent-onset polyarthritis to the Early Arthritis Clinics at the Royal Adelaide and The Queen Elizabeth Hospitals as well as private practices of participating rheumatologists were followed prospectively for 3 years. The study was approved by the Research Ethics
Patient Characteristics
Of 84 consecutive patients presenting with recent-onset polyarthritis to the Early Arthritis Clinic (Fig. 2), 18 did not meet entry criteria. A further 2 patients refused to participate in a research study and 3 refused MTX, so 61 received triple therapy and were followed for treatment safety for 3 years (Fig. 2). Of the 61 patients initiating triple therapy, 48 with disease duration of less than 6 months were included in a separate efficacy analysis. The characteristics of these patients at
Discussion
Our approach was designed to meet the individual needs of patients in an orderly process based on a predefined treatment plan that utilized, from the outset, a combination of DMARDs of established efficacy and included adjustments according to response and tolerance. The objective was to achieve early, high rates of disease suppression/remission with acceptable levels of toxicity. This report documents the feasibility and effectiveness of the approach in a routine clinic setting. After a period
Acknowledgments
Many thanks to Leah McWilliams for clinical metrology and data collection, Cindy Hall for data collection and analysis, and Sue Lester for data analysis. Drs. Sam Whittle, Sally Cox, Eliza Pontifex, Fin Cai, Tim Lu, and Debashish Danda assisted with patient care and data collection. A proportion of the fish oil was kindly provided as a gift from Berg LipidTech, Aarlesund, Norway. This work was supported by National Health and Medical Research Council of Australia.
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