Newswise — WASHINGTON – According to research presented this week at the American College of Rheumatology Annual Meeting in Washington, D.C., early and effective treatment by a rheumatologist may halt disease progression in people with rheumatoid arthritis.
Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, limitation of motion and loss of function of multiple joints. Though joints are the principal areas affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.
The first weeks and months following the onset of rheumatic disease symptoms are known as the “window of opportunity,” and it is crucial that patients get appropriate treatment in that time period to avoid long-term complications. A rheumatologist is a physician who treats rheumatic diseases, arthritis and other diseases of the muscles, joints and bones. Previous studies have found that specialty care by a rheumatologist can prevent damage to joints and other organs, improve long-term function, and increase the likelihood of achieving disease remission or no disease symptoms.
Researchers from the Hopital Lapeyronie in France completed a five-year study called ESPOIR. The study analyzed patients with early rheumatoid arthritis defined by less than six months of disease activity. Patients had either a confirmed diagnosis of RA or a high probability of developing RA, but were not being treated with disease-modifying anti-rheumatic drugs (also called DMARDs) or steroids. Researchers followed patients every six months during the first two years. After the two-year period, patient monitoring was reduced to once a year. Researchers conducted additional tests to predict the progression of rheumatoid arthritis.
“This study evaluated the five-year outcome of a large cohort of patients with very early RA,” says Bernard G. Combe, MD, PhD, lead investigator of the study and physician at the Hopital Lapeyronie in Montpellier, France. “This trial confirmed the trend towards milder disease in rheumatoid arthritis since the beginning of the 2000s.” The study evaluated 813 patients average age 48 years-old, average DAS 28 (disease activity score) 5.1, corresponding to moderate to severe disease activity, and 44 percent of patients had a positive rheumatoid factor.
At the beginning of the study, 22 percent of patients displayed bone and joint damage in the hands and feet on X-ray. Nearly 79 percent of the participants met the 2010 American College of Rheumatology/ European League Against Rheumatism Criteria for RA at study entry, with 93.8 percent meeting the criteria during follow-up.
At the five-year follow up visit, 573 patients were evaluated. In this group, RA disease activity was considered mild. The disease was well controlled over time as measured by the DAS 28 disease activity score and the Health Assessment Questionaire. Minimal progression of joint damage was seen in X-rays. In follow-up, nearly 83 percent of the patients received at least one DMARD (mainly methotrexate) and 18.3 percent of the participants were treated with newer therapies called biologics such as adalimumab (Humira®), etanercept (Enbrel®) or infliximab (REMICADE®). Almost 60 percent of the group received the steroid prednisone daily as an additional medication (average dosage of 8.8 ± 7.7 mg/day).
In this large study of rheumatoid arthritis patients at risk for developing severe disease, early evaluation and treatment by rheumatologists has resulted in mild disease outcome. According to Dr. Combe, “Early referral to a rheumatologist, early effective treatment and close monitoring are key points in managing rheumatoid arthritis in daily practice.”
This study was supported by the French Society of Rheumatology, Institut National de la Santé et de la Recherche Medicale and grants from Merck, Pfizer, Abbott and Roche.
The American College of Rheumatology is an international professional medical society that represents more than 9,000 rheumatologists and rheumatology health professionals around the world. Its mission is to advance rheumatology. The ACR/ARHP Annual Meeting is the premier meeting in rheumatology. For more information about the meeting, visit www.acrannualmeeting.org or join the conversation on Twitter by using the official hashtag: #ACR2012.
Learn more about living well with rheumatic disease as well as rheumatologists and the role they play in health care. Also, discover the ACR’s Simple Tasks campaign, which highlights the severity of rheumatic diseases and the importance of early and appropriate referral to a rheumatologist.
Editor’s Notes: Bernard G. Combe, MD, will present this research during the ACR Annual Meeting at the Walter E. Washington Convention Center at 5:45 PM on Sunday, November 11 in the Renaissance Washington - Grand Ballroom North.
Presentation Number: 830
Five-Year Favourable Outcome of Patients with Early Rheumatoid Arthritis in the 2000s: Data From the Espoir Cohort
Bernard G. Combe (Hopital Lapeyronie, Montpellier, France) Nathalie Rincheval (Institut Universitaire de Recherche Clinique, Montpellier, France)Joelle Benessiano (Rheumatology, Paris Unervisity Hospital BICHAT, Paris, France)Francis Berenbaum (Rheumatology, Paris Unervisity Hospital BICHAT, Paris, France)Alain G. Cantagrel (Hopital Purpan, Toulouse CEDEX Toulouse, France)Jean-Pierre Daurès (Institut Universitaire de Recherche Clinique, Montpellier, France)Maxime Dougados (Paris-Descartes University, APHP, Cochin Hospital, Paris, France)Patrice Fardellone (Paris-Descartes University, APHP, Cochin Hospital, Paris, France)Bruno Fautrel (APHP-Pitie Salpetriere Hospital / UPMC, Paris, France)Rene-Marc Flipo (APHP-Pitie Salpetriere Hospital / UPMC, Paris, France) Philippe Goupille (Hopital Trousseau, Tours, France)Francis Guillemin (Faculte de Medecin/BP 184, Vandoeuvre-les-Nancy, France) Xavier X. Le Loet France (CHU de ROUEN, Rouen, France)Isabelle Logeart (Pfizer, Paris, France)Xavier Mariette (Université Paris-Sud, Le Kremlin Bicetre, France)Olivier Meyer (Hopital Bichat, Paris, France)Philippe Ravaud (Hotel Dieu University hospital, Paris, France)Alain Saraux (CHU de la Cavale Blanche, Brest Cedex, France)Thierry Schaeverbeke (Groupe Hospitalier Pellegrin, Bordeaux, France)Jean Sibilia (CHU Hautepierre, Strasbourg, France)
Background/Purpose: To report the five-year outcome of a large national multicentre, longitudinal and prospective cohort of patients with very early arthritis and rheumatoid arthritis (RA) , the so-called “ESPOIR cohort study”.
Methods: Patients were recruited if they had early arthritis of less than 6 months disease duration, a high probability to develop RA, and if they were DMARD and steroids naïve. Patients have been followed every 6 months during the first 2 years then every year. Logistic regression analysis was used to determine predictive factors of outcome. Results: 813 patients were included. The mean age was 48.1 ± 12.6 years, the main delay for referal was 103.1 ± 52.4 days. DAS28 score was 5.1 ± 1.3, HAQ DI was 1.0 ± 0.7. 44.2 % and 38.8 % had respectively IgM rheumatoid factor or anti-CCP antibodies. These rate remained stable during follow-up. 22 % of the patients had erosions on hand or feet at baseline. 78.5 % of the patients fulfilled the 2010 ACR/EULAR criteria for RA at baseline and 93.8 % during follow-up.573 patients were evaluated at the 5-year follow-up visit. The outcome was rather mild in most of the patients. Disease activity (median DAS28 score: 2.5) and HAQ DI (median: 0.3) were well controlled overtime. The annual rate of radiographic progression was low (2.9 modified Sharp score unit/year). A minority of the patients required joint surgery and no increased risk of co-morbidities was observed. During the 5-year follow-up, 82.7% of the patients received at least one DMARD, which was mainly MTX (n=536; 65.9 %) usually prescribed as monotherapy.18.3 % of the included patients were treated with a biological DMARD and almost 60 % of the whole cohort received at least once, prednisone with a mean dosage of 8.8 ± 7.7 mg/day. Anti-CCP antibodies were the best predictive factor of radiographic progression, prescription of both synthetic or biologic DMARDs or still being followed in the cohort at 5-year. Conclusion: The quite favourable 5-year outcome of this very early RA cohort highlights the need for early referral, early effective treatment and close monitoring in the management of patients with early arthritis in daily practice.
Disclosure: Bernard G. Combe, None; N. Rincheval, None; J. Benessiano, None; F. Berenbaum, None; A. G. Cantagrel, None; J. P. Daurès, None; M. Dougados, None; P. Fardellone, None; B. Fautrel, None; R. M. Flipo, None; P. M. Goupille, None; F. Guillemin, None; X. X. Le Loet, None; I. Logeart, None; X. Mariette, None; O. Meyer, None; P. Ravaud, None; A. Saraux, None; T. Schaeverbeke, None; J. Sibilia, None.
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