Failure in longterm treatment is rare in actively treated patients with rheumatoid arthritis, but may be predicted by high health assessment score at baseline and by residual disease activity at 3 and 6 months: the 5-year followup results of the randomized clinical NEO-RACo trial.

With modern initial aggressive combination treatments with synthetic disease-modifying antirheumatic drugs (sDMARD), most patients with rheumatoid arthritis (RA) achieve remission, have marginal radiographic progression, and sustain normal function. Here we aim to identify the patients failing these targets even after aggressive treatment.
Ninety-nine patients with early, active RA were treated with a combination of 3 sDMARD and prednisolone (PRD), and either infliximab or placebo infusions during the first 6 months, aiming at strict remission. After 24 months, the treatments became unrestricted. At 60 months, 4 evident clinical features of treatment failure were defined: area under curve (AUC) between 6-60 months for disease activity score assessing 28 joints > 2.6; AUC 6-60 for health assessment questionnaire > 0.5; progression in total Sharp/van der Heijde score 0-60 months > 3 units; and need of PRD or biologic DMARD treatment at 60 months.
A total of 93 patients were followed up for 60 months. Of them, 45 had no features of treatment failure, 30 had 1, 10 had 2, 7 had 3, and 1 patient had all 4 features. Having 2-4 features of treatment failure at 5 years was predicted by the health assessment score at baseline, and by even low residual disease activity at 3 and 6 months.
Only 20% of the patients with RA treated early with combination sDMARD and PRD have more than 1 clinical feature of treatment failure at 60 months. Residual clinical disease activity at 3-6 months was the most important predictor for identifying these patients. The study was registered at www.clintrials.gov (NCT00908089).
AuthorsVappu Rantalaiho, Hannu Kautiainen, Salme Järvenpää, Markku Korpela, Timo Malmi, Pekka Hannonen, Oili Kaipiainen-Seppänen, Timo Yli-Kerttula, Timo Möttönen, Anu Mustila, Anna Karjalainen, Leena Paimela, Toini Uutela, Marjatta Leirisalo-Repo,
JournalThe Journal of rheumatology (J Rheumatol) Vol. 41 Issue 12 Pg. 2379-85 (Dec 2014) ISSN: 0315-162X [Print] Canada
PMID25274892 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References
  • Antirheumatic Agents
  • Biological Products
  • Prednisolone
  • Adult
  • Antirheumatic Agents (therapeutic use)
  • Arthritis, Rheumatoid (diagnosis, drug therapy, radiography)
  • Arthrography
  • Biological Products (therapeutic use)
  • Disease Progression
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Patient Outcome Assessment
  • Predictive Value of Tests
  • Prednisolone (therapeutic use)
  • Severity of Illness Index
  • Time Factors
  • Treatment Failure
  • Treatment Outcome

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