Article

Patient-reported outcomes in a randomized trial comparing four different treatment strategies in recent-onset rheumatoid arthritis.

Leiden University Medical Center, Leiden, The Netherlands.
Arthritis & Rheumatism (impact factor: 7.87). 01/2009; 61(1):4-12. DOI:10.1002/art.24367 pp.4-12
Source: PubMed

ABSTRACT To investigate the effectiveness of 4 different treatment strategies for recent-onset rheumatoid arthritis (RA) on 2-year patient-reported outcomes, including functioning and quality of life.
A total of 508 patients with recent-onset RA were randomly assigned to 1) sequential monotherapy, 2) step-up combination therapy, both starting with methotrexate, 3) initial combination therapy, including a tapered high-dose prednisone, or 4) initial combination therapy with methotrexate and infliximab. Treatment was adjusted every 3 months if the Disease Activity Score (DAS) remained >2.4. The McMaster Toronto Arthritis Patient Preference Disability Questionnaire, the Short Form 36 (SF-36), and scores for pain, global health, and disease activity measured on a 100-mm visual analog scale (VAS) were compared between groups at baseline and every 3 months thereafter for 2 years.
After 2 years, all patient-reported outcomes had improved significantly from baseline, irrespective of the treatment strategy. SF-36 subscale scores approached population norms for 3 physical components, and achieved population norms (P > 0.05) for bodily pain and 4 mental components. Improvement in functioning, VAS scores, and physical items of the SF-36 occurred significantly earlier in patients treated with initial combination therapies (all comparisons after 3 months: overall P < 0.001; P < 0.05 for groups 1 and 2 versus groups 3 and 4).
All 4 DAS-driven treatment strategies resulted in substantial improvements in functional ability, quality of life, and self-assessed VAS scores after 2 years. Initial combination therapy led to significantly faster improvement in all patient-reported measures.

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Keywords

2 years
 
4 DAS-driven treatment strategies
 
4 different treatment strategies
 
4 mental components
 
disease activity
 
Disease Activity Score
 
functional ability
 
groups 3
 
initial combination therapies
 
Initial combination therapy
 
patient-reported measures
 
population norms
 
recent-onset RA
 
recent-onset rheumatoid arthritis
 
self-assessed VAS scores
 
SF-36 subscale scores
 
Short Form 36
 
substantial improvements
 
treatment strategy
 
VAS scores