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Methotrexate and Sulfasalazine May Retard Damage in Rheumatoid Arthritis During First Year

Pre-diagnosis rates of radiological progression can be used to quantitatively measure the potential efficacy of disease-modifying anti-rheumatic drugs (DMARD) therapy in patients with new-diagnosis rheumatoid arthritis (RA), according to a recently published study.

The results also indicated that methotrexate (MTX) and sulfasalazine (SSZ), but not auranofin (AUR,) might significantly retard radiographic damage in the first year following diagnosis.

Marius Wick, MD, and colleagues from the Karolinska Hospital in Stockholm, Sweden, analysed 149 non-randomised patients newly diagnosed with RA who were evaluated clinically within one year of symptom onset. They started DMARD therapy within 2 months of first presentation to the clinic, underwent at least 1 year of follow up and had at least 2 sets of radiographs of the hands and feet taken at baseline and during follow up. Divided into 4 groups, 1 group was prescribed to receive MTX, 1 group to SSZ, and 1 group to AUR. A fourth group was the control group consisting of poor responders who changed their medication at least twice.

Taking the first onset of symptoms as the earliest starting date for radiological damage, the pre-diagnosis rate of progression was calculated and compared to the observed progression rate during the first year of DMARD therapy. Radiographs were quantified using the Larsen erosion score. The aggregate Larsen score was modified by combining grades 0 and 1, so that the scale was between 0 and 4 and the maximum possible score was 160.

They found that clinical outcomes such as tender joint count (TJC), swollen joint count (SJC) and the disease activity score (DAS28) improved from baseline to 1 year under DMARD therapy but not in the control group. When comparing the estimated pre-diagnosis progression rate using the Larsen scores to that progression seen during the first year of treatment, attenuation in the progression rate was seen in all groups. The reduction in the radiographic progression rate in the MTX and SSZ was greater (71% and 73% respectively) and statistically significant, whereas the reductions in progression rate were smaller and not significant in the AUR and control groups (43% and 41% respectively).

"Estimates of pre-diagnosis radiographic progression can be used quantitatively to assess the potential therapeutic efficacy of DMARDs in early RA, and suggest that both MTX and SSZ, but not AUR, significantly retard radiographic damage in the first year after diagnosis," said Dr. Wick.

Ann Rheum Dis 2004 Apr 19 doi:10.1136/ard.2004.020636. "Estimated Pre-diagnosis Radiological Progression: an important tool for studying the effects of early DMARD- therapy in rheumatoid arthritis"

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