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Sustained Remission and Reduced Radiographic Progression with Combination Disease Modifying Antirheumatic Drugs in Early Rheumatoid Arthritis
HEIDI MÄKINEN, HANNU KAUTIAINEN, PEKKA HANNONEN, TIMO MÖTTÖNEN, MARJATTA LEIRISALO-REPO, LEENA LAASONEN, MARKKU KORPELA, HARRI BLÅFIELD, MIKKO HAKOLA, and TUULIKKI SOKKA ABSTRACT. Objective. To study sustainability of remission and good treatment response, and the association of both with radiographic progression, in early rheumatoid arthritis (RA) in the Finnish Rheumatoid Arthritis Combination Therapy trial (FIN-RACo). Methods. Patients were randomized to receive either a combination of disease modifying antirheumatic drugs (DMARD; COMBI, n = 97) or a single DMARD (SINGLE, n = 98). Remission was defined according to modified American College of Rheumatology (ACR) remission criteria and Disease Activity Score 28 joint count (DAS28) < 2.6, and sustained remission as presence of remission at 6, 12, and 24 months. Good treatment response was defined as DAS28 ≤ 3.2 and decrease of DAS28 > 1.2. Results. In 169 patients with complete data, 33 (42%) COMBI and 18 (20%) SINGLE patients achieved modified ACR remission at 2 years, which was sustained in 11 (14%) COMBI and 3 (3%) SINGLE patients. Fifty-four (68%) COMBI and 37 (41%) SINGLE patients were in DAS28 remission at 2 years, which was sustained in 40 (51%) COMBI and 14 (16%) SINGLE patients. Good treatment response was sustained in 67% of COMBI and 27% of SINGLE patients. Over 2 years, the Larsen score increased by a median of 1 (95% CI 0–2) in patients in sustained DAS28 remission compared to 4 (95% CI 2–16) in patients who were in DAS28 remission at 6 months but lost it later; and by 6 (95% CI 2–10) in patients who were not in remission at 6 months. Conclusion. A remarkable proportion of patients with early RA treated with combinations of DMARD were in remission at 2 years, and remission was more often sustained compared to patients treated with a single DMARD. Sustained remission protects against radiographic joint damage. (First Release Dec 15 2006; J Rheumatol 2007;34:316–21) Key Indexing Terms:
REMISSION From Jyväskylä Central Hospital, Jyväskylä; Rheumatism Foundation Hospital, Heinola; Turku University Hospital, Turku; Helsinki University Central Hospital, Helsinki; Helsinki Medical Imaging Center, University of Helsinki, Helsinki; Tampere University Hospital, Tampere; Seinäjoki Central Hospital, Seinäjoki, Finland; and Vanderbilt University Medical School, Nashville, TN, USA. H. Mäkinen, MD; P. Hannonen, MD, PhD; M. Hakola, MD, Jyväskylä Central Hospital; H. Kautiainen, BA, Rheumatism Foundation Hospital; T. Möttönen MD, PhD, Turku University Hospital; M. Leirisalo-Repo, MD, PhD, Helsinki University Central Hospital; L. Laasonen, MD, PhD, Helsinki Medical Imaging Center; M. Korpela MD, PhD, Tampere University Hospital; H. Blåfield, MD, Seinäjoki Central Hospital; T. Sokka, MD, PhD, Jyväskylä Central Hospital, Vanderbilt University Medical School. Address reprint requests to Dr. H. Mäkinen, Jyväskylä Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland. E-mail: heidi.makinen@ksshp.fi Accepted for publication October 29, 2006.
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