Newly diagnosed rheumatoid arthritis (RA) patients might find new hope through a systematic medical program. A new study shows that the guided approach offered complete remission of rheumatoid arthritis for nine months to a year in 51% of the patients studied, and 15% of the patients were able to avoid traditional drugs used to treat rheumatoid arthritis during their 8.2-year follow-up.
Successful treatment was found “by adhering to a tight step-up DMARD [disease-modifying anti-rheumatic drug] treatment scheme aimed at remission - starting with low-dose methotrexate, with stepped-up dosing if necessary, followed by the addition of other traditional DMARDs or an anti–tumor necrosis factor–alpha (TNF-alpha) inhibitor,” according to Ina Kuper, MD, a staff rheumatologist at the Medisch Spectrum Twente in Enschede, the Netherlands. The study was reported at the European League Against Rheumatism Annual Congress, (EULAR, 2008)
The patients initially received 15mg/week of Methotrexate. If remission had not occurred in eight weeks, the dose was increased to 25mg/week. If needed by week twelve, 2grams/day of sulfasalazine was added, and increased to 3grams/day by by week 20. If no remission occurred at week 24, adalimumab (Humira) was added. The medicines were adjusted every three months to provide sustained remission, as determined by the patient’s disease activity score calculator (DAS28). Additions to treatment included non-steroidal anti-inflammatory drugs and low dose Prednisolone, not to exceed 10mg/day. The authors of the study noted that the average time to remission was 25 weeks, with the onset at 20 weeks. Fifteen percent of patients responded during the initial eight weeks.
The study was performed in the Netherlands, where patients and physicians find it risky to begin treatment with high doses of steroids because of the side effects. Guidelines for the treatment of RA restrict prescribing TNF-blockers unless the disease affects 28 joints, per the DAS28 score, after the administration of Methotrexate.
Patients who have a family history of RA, obesity, history of smoking, or who have had RA for longer periods, were not as likely to respond. Lab findings that limited the patient’s success included the presence of immunoglobulin M rheumatoid factor, anticyclic citrullinated peptide (anti-CCP) antibodies, and shared epitope alleles. Non-smokers, with new onset of RA, low body mass index, older age, and with absent anti-CCP antibodies were the most responsive to the prescribed regimen.
The findings give hope for anyone who has been newly diagnosed with rheumatoid arthritis. Obtaining an early diagnosis, smoking cessation and weight loss can contribute to successful treatment of patients with new-onset rheumatoid arthritis.
EULAR 2008: The European League Against Rheumatism Annual Congress: Abstracts OP-0002and OP-0003. Presented June 11, 2008. ◦
