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Intense Therapy Not Effective for Stable RA

Aggressive treatment in a hospital no better than symptom control in a primary care setting

MONDAY, May 8 (HealthDay News) -- Intensified treatment with traditional disease-modifying antirheumatic drugs in a hospital setting provides no additional benefit in preventing deterioration in patients with stable, established rheumatoid arthritis than symptom control in a primary care setting, according to a study in the May issue of Rheumatology.

Deborah Symmons, M.D., of the University of Manchester in the U.K., and colleagues enrolled 466 subjects who had rheumatoid arthritis for more than five years and had been on stable therapy for at least six months. Patients were randomized to either adequate symptom control/shared care setting (SCSC) and were managed in a primary care setting, or aggressive treatment/hospital setting (ATH) and were managed predominately in a hospital setting with the aim of suppressing clinical and laboratory evidence of inflammation.

After three years, 399 subjects who had completed the trial were evaluated using the Health Assessment Questionnaire (HAQ). The HAQ results indicated significant deterioration in both groups. The mean HAQ score increased from 1.25 to 1.40 in the SCSC arm, and from 1.31 to 1.45 in the ATH group. The adjusted mean difference was not significant between the groups.

"Patients in the SCSC arm were able to initiate treatment changes when their symptoms deteriorated without frequent hospital assessment," the authors write. "Pending further evidence, the model of shared care with annual hospital review is as good as four-monthly hospital review for these patients."

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