Early versus Delayed Treatment in Patients with Recent-onset Rheumatoid Arthritis: Comparison of Two Cohorts Who Receive

1. Early versus Delayed Treatment in Patients with Recent-onset Rheumatoid Arthritis: Comparison of Two Cohorts Who Received Different Treatment Strategies Lard, L., H. Visser, I. Speyer, I. vander Horst-Bruinsma, A. Zwinderman, F. Breedveld, J. Hazes. 2001. American Journal of Medicine. October: 111(6): 446-451. Presented by Wislaine Coby

2. What is rheumatoid arthritis? • An autoimmune disease that causes chronic inflammation of the joints. • Two million Americans are affected of all ages. • Most common in women

3. Cause • The cause is not known • Suspicions of infectious agents such as viruses and bacteria but no proof as the cause. • May be genetically inherited

4. Signs and Symptoms • Stiffness • Pain • Swelling • Redness • Fatigue

5. Normal and Arthritic Joint

6. Diagnosis of Definite or Probable RA • Morning stiffness for more the 30 minutes • More than five swollen joints • Ritchie score greater than 15 • Erythrocyte sedimentation rate greater than 28 mm/h

7. Other Requirements • Radiographic joint damage, measured by modified Sharp score • Health assessment questionnaire • Modified disease activity score • C-reactive protein level

8. Treatment Strategies • (DMARD) disease modifying antirheumatic drug=helps to slow the progression of the disease • (NSAID) nonsteroidal anti-inflammatory drugs=reduces pain and inflammation. Early treatment:(DMARD) disease modifying antirheumatic drug and (NSAID) nonsteroidal anti-inflammatory drugs (two weeks after) Delayed treatment:(NSAID) nonsteroidal anti-inflammatory drugs and (DMARD) disease modifying antirheumatic drug (used after several months)

9. Prescribed dose on type of DMARD • Chloroquine: 300 mg/day for the first month • Salazopyrine: 2000 mg/day

10. Results of study • From 1993 of January to 1995 of December, 109 patients with probable or definite disease were included. • From 1996 of January – 1998 of December, 97 patients with arthritis were included.

11. Characteristics of the two groups

12. Chart Analysis • Patients in the early treatment group showed very little progression of joint destruction

13. Treatment with dmd

14. Modified Sharp Score • Progression of radiographic joint damage was the same at 6 months for both group. • Early: stabilized at 3.5 • Delayed: progressed at 10

15. Median Disease Activity Score/C-reactive Protein Level •Early treatment showed greater improvement for the mdas; •Low levels in the Crpl (322) and the mdas (64) •Delayed had high levels in the Crpl (486) and mdas (73) C-reactive Protein Level

16. Side Effects Delayed • 3patients had to change initial therapy due to side effects • First treatment changed because lack of efficacy in 10 patients. • 4 patients changed initial therapy without dmard Early • 12 patients changed treatment due to adverse affects • 21 patients discontinued treatment due to lack of efficacy. • 8 patients changed initial therapy without dmard

17. Conclusion • Early treatment is crucial to reduce any symptoms, maximize joint function and prevent joint destruction and deformity. • DMAD has very little side effects and is a better drug to treat patients with early RA.

18. QUESTIONS