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ACR: Early Treatment May Slow Arthritis Progression

Rheumatoid arthritis patients on methotrexate have less joint damage

THURSDAY, Nov. 16 (HealthDay News) -- Treating rheumatoid arthritis patients early can slow joint damage and disease progression, according to two studies presented at the American College of Rheumatology Annual Scientific Meeting in Washington, D.C.

Tom W.J. Huizinga, M.D., from Leiden University Medical Center in the Netherlands, and colleagues randomized 110 patients with undifferentiated arthritis to receive either 15 mg/week of methotrexate or placebo. Methotrexate was discontinued after 12 months. Joint damage was assessed every six months by radiographs of the hands and feet.

After 30 months, significantly fewer patients receiving methotrexate had progressed to rheumatoid arthritis, and they had less joint damage over 18 months. This slowed progression was only observed in patients with antibodies against cyclic citrullinated peptides.

Sjoerd Van Der Kooij, M.D., also from Leiden University Medical Center, and colleagues treated 120 patients with early rheumatoid arthritis with 3 mg/kg infliximab and 25 mg/week of methotrexate. Infliximab and methotrexate were increased, discontinued or restarted based on disease-activity score.

After three years, 53 percent of patients had discontinued infliximab with a disease activity score of less than 2.4. Twenty-seven percent of these patients were able to discontinue all anti-rheumatic drugs and remain in clinical remission with no further joint damage.

"These findings indicate that initial treatment with methotrexate plus infliximab may alter the course of early rheumatoid arthritis," the authors conclude.

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