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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EEarly treatment with a combination of methotrexate and infliximab may be effective in inducing remission and altering the course of early rheumatoid arthritis, according to the results of the BeST study.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EEarly treatment with a combination of methotrexate (MTX) and infliximab (IFX) may be effective in inducing remission and altering the course of early rheumatoid arthritis (RA), according to the results of a study presented by Cornelia F. Allaart, MD, Leiden University Medical Center, Leiden, The Netherlands.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EThe BeSt study was a randomized trial comparing 4-year clinical and radiological outcomes using 4 different treatment strategies (groups) in patients with early and active RA [Goekoop-Ruiterman YP et al. \u003Cem\u003EAnn Intern Med\u003C\/em\u003E 2007]. Patients in Group 4 (n=120) started treatment with IFX 3 mg\/kg + MTX 25 mg\/week. IFX treatment was adjusted every 8 weeks (ie, prior to each IFX infusion; if IFX was stopped the DAS was calculated every 3 months) throughout the study period based on Disease Activity Scores (DAS). In case of a continued DAS \u22642.4, IFX was discontinued and MTX was tapered to 10 mg\/week. Beginning in year 3, MTX 10 mg\/week was tapered to zero if the DAS remained \u0026lt;1.6.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EDisease progression over the course of the trial was determined by the Health Assessment Questionnaire (HAQ) and the van der Heijde modification of the Sharp score (SHS) to assess damage on hand and foot x-rays at initiation of the trial and at 4 years.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EAfter 4 years, 113 patients remained in the study; 61 had successfully discontinued IFX after a mean of 13 months. At year 4 all of these patients had maintained a DAS \u22642.4, indicating a mean IFX-free period of 35 months. Twenty (20) of these patients had stopped all anti-rheumatic therapy and maintained a DAS \u0026lt;1.6 (mean 12 months without DMARDs).\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EDuring the 4\u003Csup\u003Eth\u003C\/sup\u003E year, 4 patients who had previously discontinued all anti-rheumatic drugs were restarted on MTX (due to a DAS \u22651.6); 6 others who were on MTX monotherapy stopped using this medication. Four (4) patients who had previously discontinued IFX were required to restart, resulting in 22 patients on MTX+IFX combination therapy after 4 years. Thirty (30) patients failed on MTX+IFX and proceeded as per the protocol to the next pre-specified treatment steps.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003ESHS progression (\u0026gt;SDC, smallest detectable change) after 4 years was highest in patients who had failed MTX+IFX and minimal in the 20 patients who discontinued all anti-rheumatic therapy (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/4\/14.1\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Percent of Patients with Progression SHS.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1562879076\u0022 data-figure-caption=\u0022Percent of Patients with Progression SHS.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/4\/14.1\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/4\/14.1\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/4\/14.1\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11154\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EPercent of Patients with Progression SHS.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EFour (4) years after receiving IFX and MTX as initial treatment for RA, 17% of patients have discontinued all anti-rheumatic medications and remain in clinical remission with minimal joint damage progression. Study leader Dr. Allaart commented, \u201cOur findings indicate that clinical remission from RA is achievable, provided effective treatment is administered early in the course of the disease.\u201d\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2007 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/7\/4\/14.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzm9b1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm9b1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}