Early Initiation of DMARD Therapy Associated With Greater Reduction in RA Disease Activity

The following article is part of conference coverage from the 2018 American College of Rheumatology and Association of Rheumatology Health Professionals (ACR/ARHP) Annual Meeting in Chicago, Illinois. Rheumatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in rheumatology. Check back for the latest news from ACR/ARHP 2018 .

CHICAGO – Initiation of disease-modifying antirheumatic drug (DMARD) therapy within 6 months of symptom onset was associated with a greater reduction in rheumatoid arthritis (RA) disease activity compared with later initiation, according to study data presented at the 2018 ACR/ARHP Annual Meeting, held October 19-24, in Chicago, Illinois.

Investigators retrospectively reviewed data from a single-site cohort of DMARD-naive patients with RA for whom baseline and 6-month follow-up multidimensional health assessment questionnaire (MDHAQ) scores were available. Patients were classified as “no delay” (<6 months) or “delay” (>6 months) based on time of DMARD therapy initiation relative to symptom onset. Disease duration was described as time from symptom onset to baseline visit at the rheumatology clinic.

The cohort comprised 74 patients, of whom 33 (45%) initiated DMARD therapy within 6 months of symptom onset and 41 (55%) initiated therapy beyond 6 months. Median symptom duration at baseline visit was by definition significantly greater in patients who had a delay in initiation (23 vs 2.2 months). Both groups experienced improvements in disease activity during the course of the study. Self-administered RA Disease Activity Index joint counts improved significantly in each group, with greater improvements observed in the no-delay group (−46%) compared with the delay group (−31%). Clinically significant improvements were observed in physical function and patient global assessment scores in both groups, with more significant changes observed in the no-delay group. Routine assessment of patient index data also improved in both groups at follow-up, with greater improvement observed in the no-delay vs the delay group (−39% vs −29%).

These data support the efficacy of DMARD treatment in disease activity reduction, with particular improvements seen with early initiation. As such, this study emphasizes the important role of early referral and treatment for patients with RA.

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Reference

Chua JR, Riad M, Hassan S, Shakoor N, Block JA, Castrejón I. Early versus delayed treatment in patients with rheumatoid arthritis (RA) in routine care at a single academic center: better response according to MDHAQ (MultiDimensional Health Assessment questionnaire) for patients starting treatment in the initial 6 months. Presented at: ACR/ARHP 2018 Annual Meeting; October 19-24, 2018; Chicago, IL. Abstract 600.

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