In patients who have early rheumatoid arthritis (RA), American College of Rheumatology (ACR) core set measures after 12 weeks of nonbiologic disease-modifying antirheumatic drug (DMARD) treatment may predict the progression of articular destruction 2 years later. Factors that predict bone destruction at an early stage could help identify the best candidates for a change of nonbiologic DMARD therapy or early treatment with a biologic DMARD.
Ichikawa and associates conducted a randomized double-blind controlled study to evaluate prognostic factors in 55 patients randomly assigned to 96 weeks of treatment with various nonbiologic DMARDs. Progressive joint destruction was evaluated using the modified Sharp method.
The patients who had the most extensive joint deterioration exhibited a low response to treatment at 12 weeks and continued to have extensive disease activity throughout the 2 years of the study. Mean values over the 96-week study period of all ACR core set measures, except for the modified Health Assessment Questionnaire, correlated strongly with the progression of articular destruction.
The authors noted that their findings support the clinical status quo of considering changes in DMARD therapy for patients with RA 3 months after the start of treatment. (For more information on early RA and biologic agents, go to the “Rheumatoid Arthritis Resource Center” on www.musculoskeletalnetwork.com to hear “RA Task Force Recommendations and the Use of Biologic Agents” the first of 4 podcasts by Stephen A. Paget, MD, of the Hospital for Special Surgery in New York.)
