Two-year clinical and radiologic follow-up of early RA patients treated with initial step up monotherapy or initial step down therapy with glucocorticoids, followed by a tight control approach: lessons from a cohort study in daily practice

Clin Rheumatol. 2014 Jan;33(1):125-30. doi: 10.1007/s10067-013-2398-9.


The objective of the study was to evaluate the effect of initial disease-modifying antirheumatic drug (DMARD) combination therapy with steroids (ICTS) and DMARD monotherapy (IMT) on the clinical and radiologic evolution of patients with early rheumatoid arthritis (RA) over a 2-year treatment period, applying tight control (TC) in daily practice. Seventy-four DMARD-naive early RA patients received ICTS or IMT in a TC setting. Baseline and year 1 and year 2 X-rays of hands and feet were scored according to Sharp/van der Heijde. Rapid radiographic progression (RRP) was defined as total Sharp score (TSS) of >5 units/year. At year 1, both treatment groups achieved 50 % remission. At year 2, 37 % of IMT and 60 % of ICTS patients were in remission, despite ICTS patients having initially a more severe RA profile. RRP was found in 4/74 patients at year 1: 3 IMT and 1 ICTS patients. Remarkably, three of these four patients had no radiographic progression in the second year. Five other patients had RRP in the second year: four IMT and one ICTS patients. In a TC setting, ICTS and IMT can prevent radiographic progression in the majority of patients in the daily practice of a Belgian academic hospital over 2 years. ICTS seems to be more effective than IMT in achieving higher remission rates and less radiographic progression.

MeSH terms

  • Aged
  • Antirheumatic Agents / administration & dosage*
  • Arthritis, Rheumatoid / diagnostic imaging*
  • Arthritis, Rheumatoid / drug therapy*
  • Cohort Studies
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Foot / diagnostic imaging
  • Glucocorticoids / administration & dosage*
  • Hand / diagnostic imaging
  • Humans
  • Male
  • Middle Aged
  • Radiography
  • Remission Induction
  • Severity of Illness Index
  • Steroids / administration & dosage*
  • Surveys and Questionnaires
  • Time Factors
  • Treatment Outcome
  • X-Rays


  • Antirheumatic Agents
  • Glucocorticoids
  • Steroids