Randomized clinical trials have shown that remission in early rheumatoid arthritis (RA) is a realistic treatment goal, using combination therapy of conventional disease-modifying antirheumatic drugs (DMARDs) with high-dose prednisolone or TNF-α blockers. Methotrexate (MTX) monotherapy in very early RA and in undifferentiated arthritis also results in high remission rates. It is unknown, however, whether these results can be replicated in daily clinical practice.

Ina Kuper, MD, PhD, Medisch Spectrum Twente, Enschede, The Netherlands, presented the results of a prospective, descriptive clinical practice-based study (NCT00122382) that was conducted in a cohort of patients with recent onset RA who were DMARD-naïve. The objective of the study was to evaluate whether a step-up DMARD, tight-control approach could produce remission (defined as DAS28 <2.6).

Immediately following the clinical diagnosis of RA, patients were started on an initial dose of MTX 15 mg/week after diagnosis. If remission was not achieved at Week 8, the dose was increased to 25 mg/week. In the absence of remission at Week 12, sulfasalazine (2 grams/day) was added and, if indicated, increased to 3 grams/day at Week 20. If remission still was not achieved at Week 24, adalimumab (40 mg every 2 weeks) was added. Thereafter, therapy was adjusted every 3 months, including the use of other TNF-blockers, based on DAS28 score. Patients were permitted to use NSAIDs and prednisolone ≤10 mg/day. Intra-articular corticosteroid injections also were allowed. T-test and Pearson chi-square were used to compare baseline patient characteristics between the hospitals, and Kaplan-Meier survival curves were used to estimate the time (95% CI, weeks) to first remission and to first low disease activity (DAS28 ≤3.2).

As of January 2008, 190 patients were enrolled in the study. Dr. Kuper presented results for the first 169 patients with DAS28 at inclusion >3.2. Baseline patient characteristics are shown in Table 1.

Remission was achieved in 52.1% (38/73) at Week 36. Low disease activity was achieved by 53.3% of patients by Week 20 (Table 2). Remission was sustained in 61.5% of patients 3 months after first remission and in 53.2% of patients 6 months after first remission.

“Our results show that remission is indeed achievable in as many as half of clinical practice patients who follow this schedule, which could indicate that remission is a realistic treatment goal of daily clinical practice,” concluded Dr. Kuper.

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The editors would like to thank the many members of the EULAR 2008 presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.