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Open Access Highly Accessed Research article

Early combination disease-modifying antirheumatic drug therapy and tight disease control improve long-term radiologic outcome in patients with early rheumatoid arthritis: the 11-year results of the Finnish Rheumatoid Arthritis Combination Therapy trial

Vappu Rantalaiho1*, Markku Korpela1, Leena Laasonen2, Hannu Kautiainen35, Salme Järvenpää4, Pekka Hannonen5, Marjatta Leirisalo-Repo6, Harri Blåfield7, Kari Puolakka8, Anna Karjalainen9, Timo Möttönen10 and the FIN-RACo Trial Group

Author Affiliations

1 Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital, PO Box 2000, FI-33521 Tampere, Finland

2 Helsinki Medical Imaging Center, University of Helsinki, Tukholmankatu 8B, PO Box 20, 00014 Helsinki, Finland

3 Orton Foundation, Tenholantie 10, 00280 Helsinki, Finland

4 Medcare Foundation, Hämeentie 1, 44100 Äänekoski, Finland

5 Jyväskylä Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland

6 Helsinki University Central Hospital, Stenbäckinkatu 9, 00290 Helsinki, Finland

7 Seinäjoki Central Hospital, Hanneksenrinne 7, 60220 Seinäjoki, Finland

8 Lappeenranta Central Hospital, Valto Käkelän katu 1, 53130 Lappeenranta, Finland

9 Oulu University Hospital, PO Box 22, 90221 Oulu, Finland

10 Turku University Hospital, PO Box 52, 20521 Turku, Finland

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Arthritis Research & Therapy 2010, 12:R122  doi:10.1186/ar3060


See related editorial by Landewé, http://arthritis-research.com/content/12/4/132

Published: 24 June 2010

Abstract

Introduction

Early treatment of rheumatoid arthritis (RA) has been shown to retard the development of joint damage for a period of up to 5 years. The aim of this study was to evaluate the radiologic progression beyond that time in patients with early RA initially treated with a combination of three disease-modifying antirheumatic drugs (DMARDs) or a single DMARD.

Methods

A cohort of 199 patients with early active RA were initially randomized to receive treatment with a combination of methotrexate, sulfasalazine, and hydroxychloroquine with prednisolone (FIN-RACo), or treatment with a single DMARD (initially, sulfasalazine) with or without prednisolone (SINGLE). After 2 years, the drug-treatment strategy became unrestricted, but still targeted remission. The radiographs of hands and feet were analyzed by using the Larsen score at baseline, 2, 5, and 11 years, and the radiographs of large joints, at 11 years.

Results

Sixty-five patients in the FIN-RACo and 65 in the SINGLE group had radiographs of hands and feet available at baseline and at 11 years. The mean change from baseline to 11 years in Larsen score was 17 (95% CI, 12 to 26) in the FIN-RACo group and 27 (95% CI, 22 to 33) in the SINGLE group (P = 0.037). In total, 87% (95% CI, 74 to 94) and 72% (95% CI, 58 to 84) of the patients in the FIN-RACo and the SINGLE treatment arms, respectively, had no erosive changes in large joints at 11 years.

Conclusions

Targeting to remission with tight clinical controls results in low radiologic progression in most RA patients. Patients treated initially with a combination of DMARDs have less long-term radiologic damage than do those treated initially with DMARD monotherapy.

Trial registration

Current Controlled Trials ISRCTN18445519.