Disease-activity Score Helps Guide Treatment of New-onset RA

In recent-onset active rheumatoid arthritis (RA), regular medication adjustments based on disease-activity scores (DAS) improves clinical outcomes and possibly radiological outcomes as well, a Dutch study shows.

The study results underscore the observation that “patients are better off when disease activity is closely monitored and treatment is adjusted immediately in case of an insufficient response," lead author Yvonne Goekoop-Ruiterman, from Leiden University Medical Center, The Netherlands, noted in an email to Reuters Health.

“Systematic measurements of disease activity should become standard of care in daily clinical practice,” she added.

Using data on two cohorts of adults (average age, 54) with recent-onset active RA, Goekoop-Ruiterman and her colleagues compared the efficacy of DAS-driven therapy versus routine care. In the cohort of patients who received DAS-driven therapy, DAS was measured every 3 months, and treatment was adjusted to achieve and maintain a score no higher than 2.4 (corresponding to a Disease Activity Score in 28 Joints of greater than 3.6).

With routine care, which included corticosteroids and biologic agents, treatment was left to the physician’s discretion.

At baseline, the 234 patients in the DAS-driven therapy group and the 201 in the routine care group had similar demographic characteristics and functional ability, but the DAS treatment group had a longer median disease duration (0.5 vs 0.4 years; p = 0.016), a higher mean DAS28 score (6.1 vs 5.7; p < 0.001), more rheumatoid factor-positive patients (66% vs 42%; p < 0.001) and more patients with erosions (71% vs 53%; p < 0.001).

After 1 year, patients receiving DAS-driven therapy had better clinical outcomes than patients receiving routine care, despite worse clinical baseline status, the investigators report in the January issue of Annals of the Rheumatic Diseases.

The mean improvement in functional ability (i.e., the Health Assessment Questionnaire) was 0.70 with DAS-driven therapy versus 0.55 with routine care (p = 0.029). The mean decrease in DAS28 was also greater with DAS-based therapy: 2.7 versus 1.9 (p < 0.001).

Moreover, after 1 year, the decrease in erythrocyte sedimentation rate (ESR) was greater with DAS-driven therapy (19 mm/hr) than with routine care (13 mm/h; p = 0.011), and the percentage of patients in clinical remission was higher (31% vs 18%; p < 0.005).

DAS-driven therapy also appeared to slow the progression of radiologic joint damage to a greater extent than routine care, the researchers report.

This study, the researchers conclude, supports DAS-driven therapy in patients with recent-onset active RA.

Reference: Ann Rheum Dis 2010;69:65-69.

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