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Can disease-modifying anti-rheumatic drugs be discontinued in long-standing rheumatoid arthritis? A 15-year follow-up
Scandinavian Journal of Rheumatology , 09/28/09

Tiippana-Kinnunen T et al. – Most of the patients with long-standing RA require continuous DMARD treatment. If the treatment is discontinued, patients should be followed-up closely and DMARDs readministered without delay if the disease flares up

Methods

15-year follow-up study
87 patients with ERA treated since diagnosis with disease-modifying anti-rheumatic drugs (DMARDs) according to the 'sawtooth' strategy
Patients divided into groups according to continuity of treatment: (A) 'continuous DMARDs', (B) 'discontinued and restarted DMARDs', and (C) 'permanently discontinued DMARDs'
Main outcome measurements included Health Assessment Questionnaire (HAQ), Larsen score, and clinical remission according ARA criteria

Results

Seventy (80%) patients participated in the 15-year follow-up
DMARDs discontinued in 20 (29%) patients due either to remission or symptom-free period of the disease
Disease flared up in nine (45%) of these patients, in some patients several years after discontinuation
At 15-year follow-up, 59 (84%) patients were on DMARDs
3 (4%) using biologicals
Functional capacity remained good in all groups
The mean Larsen score was higher (54) in group A than in groups B (25) and C (12)
Remission rate was 64% in group C and considerably lower in groups A (6%) and B (0%)

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