Duncan Porter (Gartnavel General Hospital, Glasgow, UK) and colleagues investigated whether a more intensive approach--monthly assessment of patients' disease activity score (DAS) to guide treatment with oral antirheumatic drugs and steroid injections--could be more effective in improving symptoms than standard three-monthly assessment without a DAS calculation to guide treatment.
The investigators randomized 111 people with rheumatoid arthritis to either intensive management or routine care. The study's main outcome measure was to compare the proportion of patients in each group achieving a good response to treatment--defined as a DAS below 2.4 and a fall in this score from baseline by more than 1.2 points. Comparisons between patients in the two groups were made after 18 months.
82% of patients given intensive therapy achieved a good response to treatment compared with 44% in the standard treatment group. Furthermore, 65% of patients in the intensive group were in remission at the end of the study compared with only 16% of patients in the standard group. Intensive treatment was no more costly than standard treatment.
Dr Porter comments: "The results of this study have considerable implications for the management of people with rheumatoid arthritis. Despite initial concerns, cost did not differ between intensive management of patients and routine treatment. Whether the improvement in patients' outcomes will translate into longer-term savings, such as a reduction in work disability, the need for joint-replacement surgery, or the need for institutional care, remains to be seen. More importantly, our results show that a strategy of optimising current techniques and treatment regimens can deliver substantial patients' benefits within a cost-neutral framework."
Contact: Dr Hilary Capell, Centre for Rheumatic Diseases, Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, UK;
T) 44-141-211-4965;
E) hilary.capell@northglasgow.scot.nhs.uk
Journal
The Lancet