my personal edition > rheumatoid arthritis > news


  E-Mail this DGReview to a colleague

DGReview

Single Disease Modifying Antirheumatic Drug As Effective As Combination Therapy For Early Rheumatoid Arthritis

Combined therapy with methotrexate (MTX) and sulfasalazine (SSZ) during the first year of early rheumatoid arthritis does not influence long-term inflammatory status, disability, or structural changes compared to treatment with a single disease modifying antirheumatic drug (DMARD).

"Our results could be considered as surprising because several studies have suggested that some combinations of DMARDs have a better effect on disease activity, functional status, and structural changes than monotherapy," note J. F. Maillefert of Centre Hospitalier Universitaire Dijon, Dijon, France, and colleagues.

However, the researchers also point out that with one exception, previous studies did not evaluate the effects for 3 or more years after the trial completion.

The research team carried out a 4-year multi-centre, longitudinal follow up study for 146 early rheumatoid arthritis (RA) patients previously participating in a 1-year double blind randomised trial which compared treatment with MTX alone, SSZ alone, or MTX and SSZ combined.

Patients continued a free-choice treatment strategy under the care of their own rheumatologists. The disease activity score (DAS), Health Assessment Questionnaire (HAQ), and Sharp method (modified by van der Heijde) radiological score were measured at inclusion in the original trial (baseline) and at follow up after 5 years.

Results showed no significant difference at baseline and after 5 years in mean DAS, HAQ, and radiological scores between patients in a single DMARD group and patients in the combination group. Multivariate analysis revealed no relationship between 5-year DAS, HAQ, and radiological scores and age, gender, total duration of DMARDs and corticosteriod treatment, or early initiation of single compared with combined DMARD treatment.

Researchers postulate that the contrasting results of the previous long-term study may be attributed to differences in initial treatment. Prednisolone, used as a part of the previous study treatment protocol for the first year, may have resulted in a marked suppression of inflammation and sustained reduction in radiological progression.
Ann Rheum Dis 2003 Aug;62:8:764-766. "Heavy drinking is associated with more severe psychosocial dysfunction among girls than boys in finland"

E-Mail this DGReview to a colleague

To print, use this version