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Step-up TX leads to RA remission.



Remission in early rheumatoid arthritis is a realistic treatment goal in the research setting and can be replicated in daily clinical practice, according to a prospective study of new-on-set rheumatoid arthritis patients.

The results from the ongoing study showed that tightly controlled step-up treatment with disease-modifying antirheumatic drugs (DMARDs) can lead to disease remission in routine clinical practice.

The data were presented by Dr. Ina Kuper at the annual European Congress of Rheumatology in Paris.

The study population includes a cohort of consecutive patients from three Dutch hospitals with recently diagnosed rheumatoid arthritis identified from the Dutch Rheumatoid Arthritis Monitoring Registry since January 2006. Dr. Kuper and her research associates had complete data on 169 patients. As per study protocol, treatment comprises a step-up DMARD Disease Modifying Anti-Rheumatic Drugs (DMARDs)
A class of antirheumatic drugs, including chloroquine, methotrexate, cyclosporine, and gold compounds, that influence the disease process itself and do not only treat its symptoms.

Mentioned in: Antirheumatic Drugs
 scheme aimed at remission, which is defined as a Disease Activity Score-28 of less than 2.6, said Dr. Kuper of Medisch Spectrum Twente The Medisch Spectrum Twente (MST) is the hospital of the city of Enschede. It is a top-clinical center offering secondary and limited tertiary care. Facilities
The hospitals has a license for 1070 beds, over 200 medical specialists and circa 4000 total employees.
 in Enschede, the Netherlands.

After diagnosis, treatment begins with 15 mg per week of methotrexate methotrexate, drug used in halting the growth of actively proliferating tissues. Introduced in the 1950s, it is used in the treatment of leukemia, psoriasis, and non-Hodgkin's lymphoma. , which is increased to 25 mg per week at 8 weeks if remission has not been achieved. The absence of remission at week 12 warrants the addition of 2 g of sulfasalazine sulfasalazine /sul·fa·sal·a·zine/ (-sal´ah-zen) a sulfonamide used in the treatment and prophylaxis of inflammatory bowel disease and the treatment of rheumatoid arthritis.  per day, which can be increased to 3 g per day at week 20 if indicated.

At week 24, if remission has still not been reached, adalimumab is added to the methotrexate, with therapeutic adjustments--possibly using other tumor necrosis factor tumor necrosis factor
n. Abbr. TNF
A protein that is produced in the presence of an endotoxin, especially by monocytes and macrophages, is able to attack and destroy tumor cells, and exacerbates chronic inflammatory diseases.
 inhibitors--every 3 months based on DAS28, Dr. Kuper said. During the treatment period, patients can continue to take NSAIDs, 10 mg per day of prednisolone, and intra-articular corticosteroid injections, she said.

The baseline characteristics for the first 169 patients with a DAS28 greater than 3.2 at the beginning of the study were comparable across the three hospitals, Dr. Kuper noted. The mean age of the study participants, approximately 64% of whom were female, was 57.3 years, and the mean disease duration at diagnosis was 16 weeks.

By study week 8, 15.5% of the patients achieved remission. This number rose to 22.2% at week 12, 30.7% at week 20, 38.8% at week 24, and 52.1% at week 36, and was 51.0% between weeks 48 and 52, Dr. Kuper stated. Based on Kaplan-Meier survival curves, the estimated median time to first remission was 25 weeks, she said.

"The significance of this study is the fact that it demonstrates the possibility of achieving high remission rates in patients with recent-onset rheumatoid arthritis in daily clinical practice using a step-up DMARD regimen and tight control," Dr. said in an interview. This is the first evidence that such results can be attained in routine clinical practice, she said.

BY DIANA MAHONEY

New England Bureau
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Title Annotation:Rheumatology
Author:Mahoney, Diana
Publication:Internal Medicine News
Article Type:Clinical report
Geographic Code:1USA
Date:Aug 15, 2008
Words:453
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