Outcome in patients with early rheumatoid arthritis treated according to the "sawtooth" strategy

Arthritis Rheum. 1996 Jun;39(6):996-1005. doi: 10.1002/art.1780390617.


Objective: To investigate the outcome of early rheumatoid arthritis (RA) when treated according to the "sawtooth" strategy, and to compare the results with the findings of other studies.

Methods: In this prospective study, 142 patients with early RA were treated actively with slow-acting antirheumatic drugs (SAARDs) for an average of 6.2 years, and were closely monitored clinically. Several outcome measures were applied, and the results were compared with findings in previously described cohorts.

Results: The mean cumulative number of SAARDs used during the study was 3.3. Treatment changes were made because of inefficacy more often than because of adverse events. The percentage of patients whose disease entered remission increased with time to 32% (45 of 142). Only 24% of the patients (34 of 142) had deterioration to Steinbrocker functional class III or IV. The "sawtooth" treatment strategy seemed to improve the outcome of the patients with early RA.

Conclusion: In the majority of patients with early RA, "sawtooth" therapy remains beneficial for at least 6 years. However, in one-fourth of the patients, the disease fails to respond to this drug treatment strategy.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antirheumatic Agents / administration & dosage*
  • Arthritis, Rheumatoid / complications
  • Arthritis, Rheumatoid / drug therapy*
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Remission Induction
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome


  • Antirheumatic Agents