Aggressive therapy in patients with early arthritis results in similar outcome compared with conventional care: The STREAM randomized trial
Rheumatology,  Clinical Article

van Eijk IC et al. – In patients with early arthritis of two to five joints, both aggressive tight-control therapy including adalimumab and conventional therapy resulted in remission rates around 50%, low radiographic damage and excellent functional status after 2 years. Full disease control including radiographic arrest in all patients remains an elusive target even in moderately active early arthritis.

Methods

  • Patients with 2 to 5 swollen joints, Sharp–van der Heijde radiographic score (SHS) <5 and symptom duration ≤2 years were randomized between 2 strategies
  • Patients with a definite non-RA diagnosis excluded
  • Protocol of aggressive group aimed for remission (DAS<1.6), with consecutive treatment steps: MTX, addition of adalimumab and combination therapy
  • Conventional care group followed a strategy with traditional DMARDs (no prednisone or biologics) without DAS-based guideline
  • Outcome measures after 2 years were SHS (primary), remission rate and HAQ score (secondary)

Results
  • 82 patients participated (60% ACPA positive)
  • In aggressive group (n equals 42), 19 patients were treated with adalimumab
  • In conventional care group (n equals 40), 24 patients started with hydroxychloroquin (HCQ), 2 with sulfasalazine (SSZ) and 14 with MTX
  • After 2 years, median SHS increase was 0 [interquartile range (IQR) 0–1.1] and 0.5 (IQR 0–2.5), remission rates were 66 and 49% and HAQ decreased with a mean of −0.09 (0.50) and −0.25 (0.59) in aggressive and conventional care group
  • All comparisons were non-significant

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