Abstract | OBJECTIVE: To investigate the 15-year outcome of patients with early rheumatoid arthritis (ERA) with respect to the continuity of treatment. METHODS: We conducted a 15-year follow-up study of 87 patients with ERA treated since diagnosis with disease-modifying anti-rheumatic drugs (DMARDs) according to the 'sawtooth' strategy. The patients were divided into groups according to the continuity of treatment: (A) 'continuous DMARDs', (B) 'discontinued and restarted DMARDs', and (C) 'permanently discontinued DMARDs'. The main outcome measurements included the Health Assessment Questionnaire ( HAQ), the Larsen score, and clinical remission according to the American Rheumatism Association (ARA) criteria. RESULTS: Seventy (80%) patients participated in the 15-year follow-up. DMARDs were discontinued in 20 (29%) patients due either to remission or to a symptom-free period of the disease. The disease flared up in nine (45%) of these patients, in some patients several years after the discontinuation. At the 15-year follow-up, 59 (84%) patients were on DMARDs; only three (4%) were using biologicals. Functional capacity remained good in all groups (mean HAQ score 0.52). The mean Larsen score was higher (54) in group A than in groups B (25) and C (12) (p =0.001). The remission rate was 64% in group C and considerably lower in groups A (6%) and B (0%) (p<0.001). CONCLUSIONS: Our results indicate that most of the patients with long-standing RA require continuous DMARD treatment. If the treatment is discontinued, patients should be followed-up closely and DMARDs readministered without delay if the disease flares up.
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Authors | T Tiippana-Kinnunen, L Paimela, H Kautiainen, L Laasonen, M Leirisalo-Repo |
Journal | Scandinavian journal of rheumatology
(Scand J Rheumatol)
Vol. 39
Issue 1
Pg. 12-8
( 2010)
ISSN: 1502-7732 [Electronic] England |
PMID | 20132065
(Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
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Topics |
- Adult
- Age of Onset
- Antirheumatic Agents
(administration & dosage)
- Arthritis, Rheumatoid
(diagnosis, drug therapy, epidemiology)
- Chronic Disease
- Cohort Studies
- Disease Progression
- Dose-Response Relationship, Drug
- Drug Administration Schedule
- Drug Therapy, Combination
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Probability
- Quality of Life
- Risk Assessment
- Severity of Illness Index
- Surveys and Questionnaires
- Time Factors
- Treatment Outcome
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