IMPACTS OF IMMEDIATE CHANGES IN DMARDS ON OUTCOMES IN RHEUMATOID ARTHRITIS WITH MODERATE-TO-SEVERE ACTIVITY

Abstract

Background The importance of tight control is supported by solid clinical evidence. While treating RA with the aim of achieving remission or a low disease activity-as determined by disease activity score employing 28 joints count (DAS28) or the simplified and the clinical disease activity index (SDAI, CDAI) -is reasonable and important, this approach is not widely accepted in the clinical situation.Objectives To identify the effects of tight control of rheumatoid arthritis (RA) on various disease outcomes in a large observational study.Methods We selected 1900 RA patients with a baseline DAS28-ESR of more than 3.2 and who had 1 year of follow-up data. The patients were divided into two groups: (1) disease-modifying antirheumatic drugs (DMARDs)-changed group (patients who changed the types or amounts of their DMARDs) and (2) DMARDs-unchanged group (patients who maintained their DMARDs). We measured various disease outcomes, including the Health Assessment Questionnaire?Disability Index (HAQ-DI), DAS28-ESR, C-reactive protein (CRP), ESR, and global health assessments by both physicians and patients. The t-test was used to identify the effects of tight control of RA on various disease outcomes.Results Patients in the DMARDs-changed group were younger, had a shorter disease duration, used less leflunomide, used more biologic agents. At baseline, they had higher DAS28-ESR (4.62±0.96 in DMARDs-changed group versus 4.42±0.90 in DMARDs-unchanged group, p<0.001), CRP (1.15±1.62 versus 0.81±1.14, p<0.001), global health assessment by both physician (34.05±20.00 versus 26.94±18.16, p<0.001) and patient (48.96±25.34 versus 46.18±24.74, p=0.016). In the comparison between baseline and the 1-year follow-up, the DMARDs-changed group showed greater improvements in HAQ-DI (?0.76±1.43 versus ?0.59±1.22, p=0.006), CRP (?0.39±1.71 versus ?0.11±1.37 mg/dl, p=0.001), and the global health assessment by a physician (?11.21±24.18 versus ?8.10±19.20, p=0.002).