OBJECTIVE: At 5 years' follow-up of early (<6 months) rheumatoid arthritis patients to (1) investigate whether initial combination therapy with methotrexate (MTX) and ciclosporin (CSA) (n=80) is superior to initial monotherapy with MTX (n=80) with respect to prevention of radiographic progression, (2) investigate whether the favourable clinical and radiographic response reported at 2 years in the CIMESTRA trial can be maintained and (3) identify predictors of radiographic outcome. METHODS:139 patients completed 5 years' follow-up with maintained double-blinding and a strict synovitis suppressive treatment strategy with intra-articularbetamethasone injections (intra-articular glucocorticosteroid (GC)) and escalation of disease-modifying anti-rheumatic drug treatment. Disease activity, total Sharp-van der Heijde Score (TSS) of hands, wrists and forefeet were assessed at baseline and after 3, 4 and 5 years. MRI of the wrist and anti-cyclic citrullinated peptide (anti-CCP) were assessed at baseline. RESULTS: At 5 years, TSS progression rate was <1 unit/year and 47% had not progressed radiographically since baseline. 78% were in Disease Activity Score remission, 56% in American College of Rheumatology remission and 17% withdrawn from treatment due to remission. There were no differences between initial treatment groups. MRI-bone marrow oedema, TSS and anti-CCP predicted radiographic progression at 5 years. CONCLUSION: Early and strict synovitis suppressive treatment with MTX and intra-articular GC lead to high remission rates and halting of erosive progression at 5 years. No additional effect of initial combination therapy with CSA was found. The results parallel those reported for tumour necrosis factor α antagonists. Baseline MRI-bone oedema, TSS and anti-CCP predicted radiographic progression.
RCT Entities:
OBJECTIVE: At 5 years' follow-up of early (<6 months) rheumatoid arthritispatients to (1) investigate whether initial combination therapy with methotrexate (MTX) and ciclosporin (CSA) (n=80) is superior to initial monotherapy with MTX (n=80) with respect to prevention of radiographic progression, (2) investigate whether the favourable clinical and radiographic response reported at 2 years in the CIMESTRA trial can be maintained and (3) identify predictors of radiographic outcome. METHODS: 139 patients completed 5 years' follow-up with maintained double-blinding and a strict synovitis suppressive treatment strategy with intra-articularbetamethasone injections (intra-articular glucocorticosteroid (GC)) and escalation of disease-modifying anti-rheumatic drug treatment. Disease activity, total Sharp-van der Heijde Score (TSS) of hands, wrists and forefeet were assessed at baseline and after 3, 4 and 5 years. MRI of the wrist and anti-cyclic citrullinated peptide (anti-CCP) were assessed at baseline. RESULTS: At 5 years, TSS progression rate was <1 unit/year and 47% had not progressed radiographically since baseline. 78% were in Disease Activity Score remission, 56% in American College of Rheumatology remission and 17% withdrawn from treatment due to remission. There were no differences between initial treatment groups. MRI-bone marrow oedema, TSS and anti-CCP predicted radiographic progression at 5 years. CONCLUSION: Early and strict synovitis suppressive treatment with MTX and intra-articularGC lead to high remission rates and halting of erosive progression at 5 years. No additional effect of initial combination therapy with CSA was found. The results parallel those reported for tumour necrosis factor α antagonists. Baseline MRI-bone oedema, TSS and anti-CCP predicted radiographic progression.
Authors: K Krüger; J Wollenhaupt; K Albrecht; R Alten; M Backhaus; C Baerwald; W Bolten; J Braun; H Burkhardt; G Burmester; M Gaubitz; A Gause; E Gromnica-Ihle; H Kellner; J Kuipers; A Krause; H-M Lorenz; B Manger; H Nüßlein; H-G Pott; A Rubbert-Roth; M Schneider; C Specker; H Schulze-Koops; H-P Tony; S Wassenberg; U Müller-Ladner Journal: Z Rheumatol Date: 2012-09 Impact factor: 1.372
Authors: Haitao Yang; Julien Rivoire; Michael Hoppe; Waraporn Srikhum; John Imboden; Thomas M Link; Xiaojuan Li Journal: Skeletal Radiol Date: 2014-12-10 Impact factor: 2.199
Authors: Ashley P Jones; Dannii Clayton; Gloria Nkhoma; Frances C Sherratt; Matthew Peak; Simon R Stones; Louise Roper; Bridget Young; Flora McErlane; Tracy Moitt; Athimalaipet V Ramanan; Helen E Foster; Paula R Williamson; Samundeeswari Deepak; Michael W Beresford; Eileen M Baildam Journal: Health Technol Assess Date: 2020-07 Impact factor: 4.014