A nine-month delay in starting therapy for people with early rheumatoid arthritis has significant effects on long-term patient outcome, according to Dr. John Esdaile, a member of the Canadian Arthritis Network and a professor at the University of British Columbia.
Esdaile is the lead author of a study being published in the March issue of The Journal of Rheumatology that looks at the consequences of delaying treatment for people with early arthritis. "Our research provides some of the strongest evidence to date in support of early therapy for rheumatoid arthritis," he explains. "We found even three years later, people who had their treatment delayed had not caught up to the group of patients whose therapy was started sooner."
Over the past decade there has been a radical change in the philosophy of treatment for rheumatoid arthritis. The traditional restrained approach to the introduction of second-line agents -- drugs that work directly on improving the disease rather than targeting the symptoms -- has been replaced by strong recommendations for early referral of suspected cases of rheumatoid arthritis and the initiation of second-line therapy within several months of the onset of symptoms.
Esdaile notes, however, that until now there has only been limited evidence that describes the effect of delayed treatment. His team evaluated the long-term effect of delaying therapy with a second-line agent called Hydroxychloroquine by following patients who had just completed a recent randomized trial called the Hydroxychloroquine in Early Rheumatoid Arthritis study (HERA).
All of the 119 participants who completed the HERA trial were invited prospectively to participate in a three-year follow-up program. At the conclusion of the follow-up study, complete data was available for 87 per cent of the original patients.
"Rheumatoid arthritis is the most disabling type of arthritis, affecting about one per cent of the population." explains Esdaile, noting this involves a population about the size of Victoria. "Delaying therapy for patients with early rheumatoid arthritis causes permanent damage."
"Early treatment of rheumatoid arthritis is the key to reducing damage and therefore reducing the need for more expensive treatments, including surgery," says Professor Claire Bombardier of the University of Toronto, a co-investigator and health economist who is also a member of the Canadian Arthritis Network.
Other members of the research team included Eva Tsakonas of McGill University, Dr. A. Fitzgerald of the University of Alberta, Dr. Mary-Ann Fitzcharles of McGill University, Dr. Alfred Cividino of McMaster University, Dr. J. Carter Thorne of Newmarket, Dr. Abdelmajid M'Seffar of the University of Montreal and Professor Lawrence Joseph of McGill University.
The Canadian Arthritis Network links more than 100 of Canada's best and brightest scientists and researchers from over 44 different institutions across Canada. It´s part of the federal Networks of Centers of Excellence Program, a joint initiative of Industry Canada and the three granting councils (the Natural Sciences and Engineering Research Council, the Medical Research Council and the Social Sciences and Humanities Research Council).
The study was funded by a grant from Sanofi-Synthelabo Canada. It follows an initial study funded by The Arthritis Society, the Medical Research Council and Sanofi-Synthelabo Canada.
Journal
The Journal of Rheumatology