Abstract
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.
- RHEUMATOID ARTHRITIS
- DISEASE ACTIVITY SCORE
- RADIOGRAPH
- REMISSION
- WINDOW OF OPPORTUNITY
- DISEASE-MODIFYING ANTIRHEUMATIC DRUGS
Footnotes
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The content of this report does not necessarily represent the official views of the National Institute on Aging or the National Institutes of Health.
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Dr. Sharp is deceased; Dr. Peter is deceased.
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Supported by NIH/NIAMS P60 AR 26834; Southern California Chapter of the Arthritis Foundation; Specialty Laboratories; and Oregon Arthritis Foundation. Dr. Khanna received support from the UCLA Older Americans Independence Center, NIH/NIA Grant P30-AG028748. Dr. Ranganath received support from the ACR/REF CIFA and UCLA Older Americans Independence Center, NIH/NIA Grant P30-AG028748.
- Accepted for publication October 30, 2009.