Early Versus Delayed Treatment in Patients With Recent-Onset Rheumatoid Arthritis: Comparison of Two Cohorts Who Received Different Treatment Strategies

Am J Med. 2001 Oct 15;111(6):446-51. doi: 10.1016/s0002-9343(01)00872-5.

Abstract

Purpose: To compare the effect of delayed and early treatment strategies on disease outcome in patients with rheumatoid arthritis.

Subjects and methods: Between 1993 and 1995, 109 patients diagnosed with probable or definite rheumatoid arthritis of recent onset were initially treated with analgesics; if they had persistent active disease, they were treated subsequently with the disease-modifying drugs chloroquine or salazopyrine (delayed treatment). Between 1996 and 1998, similar patients (n = 97) were promptly treated with either chloroquine or salazopyrine (early treatment).

Results: The median lag to the initiation of disease-modifying treatment was 15 days in the early treatment group and 123 days in the delayed treatment group. There was less radiologic joint damage after 2 years in the early treatment group (median Sharp score, 3.5; 95% confidence interval [CI]: 1 to 7) compared with the delayed treatment group (median Sharp score, 10; 95% CI: 5 to 15; P <0.05). The median area under the curve of the 2-year disease activity score was lower in the early treatment group (64 units; 95% CI: 59 to 69 units) compared with the delayed treatment group (73 units; 95% CI: 69 to 77 units; P = 0.002).

Conclusion: In this nonrandomized comparison, early introduction of disease-modifying antirheumatic drugs was associated with a better disease outcome after 2 years.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Activities of Daily Living*
  • Adult
  • Age Factors
  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / blood
  • Arthritis, Rheumatoid / diagnostic imaging
  • Arthritis, Rheumatoid / drug therapy*
  • Blood Sedimentation
  • C-Reactive Protein / analysis
  • Chloroquine / therapeutic use*
  • Cohort Studies
  • Disease Progression
  • Drug Combinations
  • Female
  • Foot / diagnostic imaging
  • Glucosamine / analogs & derivatives*
  • Glucosamine / therapeutic use*
  • Hand / diagnostic imaging
  • Health Status
  • Humans
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care
  • Radiography
  • Sulfasalazine / therapeutic use*
  • Time Factors

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Antirheumatic Agents
  • Drug Combinations
  • Salazopyrine
  • Sulfasalazine
  • Chloroquine
  • C-Reactive Protein
  • Glucosamine