Intensive treatment with MTX can increase the number of patients responding to treatment. In a two-year study conventional and intensive MTX treatment strategies were compared in the treatment of patients with early RA using a computer assisted program. In the conventional strategy, patients came to the outpatient clinic once every 3 months and were given an adjusted MTX dose based on daily practice.

In the intensive strategy, patients came to the clinic monthly and were given an adjusted dose of MTX tailored to the individual, aimed for remission, and based on predefined criteria (>20% improvement from the previous visit for the number of swollen joints, number of tender joints, ESR and VAS general well-being). In both groups, starting dose of MTX was 7.5 mg/wk and could be increased up to 30 mg/wk, if needed.

The computer program, used to determine the clinical response, was also evaluated in this study.

The endpoint of the study was the number of patients in remission defined as no swollen joints plus 2 out of 3 of the following criteria: number of tender joints ≤ 3, ESR ≤ 20 mm/hr1st, and VAS general well-being ≤ 20 mm fulfilled at three subsequent visits measured at three monthly intervals.

Sixty-three (41%) of the patients in the intensive strategy group achieved remission for at least 6 months versus 24% of the patients in the conventional strategy group (p= 0.002). Mean time until first remission was 10 months for the intensive strategy group compared with 13 months for conventional strategy group. Median (IQ 0.25–0.75 range) AUC of all clinical variables were significantly better for the intensive strategy group when compared to the conventional strategy group.

Tailoring the MTX treatment to the individual patient is significantly more beneficial than the conventional approach. Furthermore, a computer assisted approach, to make more objective decisions on dosage changes, may be beneficial.