Early clinical response to treatment predicts 5-year outcome in RA patients: follow-up results from the CAMERA study

• Published in: Annals of the rheumatic diseases Vol. 70; no. 6; pp. 1099 - 1103
• Main Authors: Bakker, M F, Jacobs, J W G, Welsing, P M J, Vreugdenhil, S A, van Booma-Frankfort, C, Linn-Rasker, S P, Ton, E, Lafeber, F P J G, Bijlsma, J W J
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.06.2011; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Adult; Aged; Antirheumatic Agents - administration & dosage; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - blood; Arthritis, Rheumatoid - diagnostic imaging; Arthritis, Rheumatoid - drug therapy; Biological and medical sciences; Biomarkers - blood; Blood Sedimentation; C-Reactive Protein - metabolism; Cameras; Clinical medicine; Disease Progression; Diseases of the osteoarticular system; Drug Therapy, Computer-Assisted; Epidemiologic Methods; Female; Humans; Inflammatory joint diseases; Male; Medical sciences; Methotrexate - administration & dosage; Methotrexate - therapeutic use; Middle Aged; Patients; Radiography; Rheumatoid arthritis; Studies; Treatment Outcome; Human; Immunopathology; Chronic; Prognosis; Treatment; Rheumatoid arthritis; Diseases of the osteoarticular system; Rheumatology; Autoimmune disease; Inflammatory joint disease; Predictive factor
• DOI: 10.1136/ard.2010.137943
• ISSN: 0003-4967

Objective To investigate the long-term effects of the tight control (TC) and conventional (CT) methotrexate-based strategies of the Computer Assisted Management in Early Rheumatoid Arthritis trial in early rheumatoid arthritis and evaluate the predictive value of an early response to treatment. Methods Clinical and radiographic 5-year outcome was compared between initial strategies. Patients were classified according to the EULAR response criteria. The prognostic value of early response to treatment in addition to established predictors was analysed by multiple linear regression analyses. Results 5 years of data were available for 205 of 299 patients, with no indication for selective drop-out. At 5 years there was no longer any significant difference for clinical and radiographic outcomes between treatment strategies applied during the first 2 years. Good-responders had a mean disease activity score of 2.39 (1.2) and median yearly radiographic progression rate of 0.6 (0.0 to 2.2) at 5 years; significantly lower (both p<0.02) when compared to moderate- and non-responders. Multiple regression analysis showed that early response to treatment is an independent predictor of 5-year outcome, irrespective of treatment strategy. Conclusions The difference in disease activity between treatment strategies disappeared over the years. Good-response to treatment independently predicts significantly better 5-year clinical and radiographic outcome. The TC principle probably should be continued in the long-term.