TUESDAY, March 20 (HealthDay News) -- An analysis of four treatment strategies suggests that all can limit the progression of rheumatoid arthritis if patients are monitored frequently and their therapy adjusted, although combination therapy is initially more successful at controlling the disease. The findings are published in the March 20 issue of the Annals of Internal Medicine.
Yvonne Goekoop-Ruiterman, M.D., of Leiden University Medical Center in Leiden, the Netherlands, and colleagues compared four treatment approaches in 508 patients with early rheumatoid arthritis: sequential monotherapy (group 1), step-up combination therapy (group 2), initial combination therapy with tapered high-dose prednisone (group 3), and initial combination therapy with infliximab (group 4). Therapies were adjusted every three months during the two-year study depending on functional ability and radiographic joint damage.
Two-thirds of patients in groups 1 and 2 required treatment adjustment, compared to 42 percent in group 3 and 28 percent in group 4. At two years, 33, 31, 36 and 53 percent of patients in groups 1 through 4, respectively, were maintained on just one drug. Physical function improved in all groups over two years, by a mean 0.6 points (as measured by health assessment questionnaire), and at the end of two years, 42 percent of all patients were in remission (compared to 31 percent after one year).
"Initial combination therapies seem to provide earlier clinical improvement and less progression of joint damage, but all treatment strategies eventually showed similar clinical improvements. In addition, combination therapy can be withdrawn successfully and less treatment adjustments are needed than with initial monotherapies," the authors write. "With intensive and objective monitoring of disease activity and adjustments of therapy, low disease activity is a realistic goal that can be achieved with all treatment strategies."
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