Vol.22 No.3

Original Article

Treatment discontinuation in patients with very early rheumatoid arthritis in sustained simplified disease activity index remission after synthetic disease-modifying anti-rheumatic drug administration

Authors

Junko Kita1 , Mami Tamai2 , Kazuhiko Arima3 , Yoshikazu Nakashima1 , Takahisa Suzuki1 , Shin-ya Kawashiri1 , Naoki Iwamoto1 , Akitomo Okada1 , Tomohiro Koga1 , Satoshi Yamasaki1 , Hideki Nakamura1 , Tomoki Origuchi4, Hiroaki Ida5, Kiyoshi Aoyagi6, Masataka Uetani7, Katsumi Eguchi8, Atsushi Kawakami1

  • Unit of Translational Medicine, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
  • Center for Health and Community Medicine, Nagasaki University, Nagasaki, Japan
  • Department of Medical Gene Technology, Atomic Bomb Disease Institute, Nagasaki, Japan
  • Department of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
  • Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
  • Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
  • Department of Radiology and Radiation Research, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
  • Sasebo City General Hospital, Sasebo, Japan
Received:

16 March 2011

Accepted:

17 August 2011

Published online:

30 September 2011

Full Text

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Abstract

We aimed to identify whether drug-free remission could be achieved in patients with very early rheumatoid arthritis (RA) with poor prognosis factors by treatment with synthetic disease-modifying antirheumatic drugs (DMARDs). Thirteen patients with very early RA, whose disease was considered to have highly erosive potential, were included. Magnetic resonance imaging (MRI)-proven bone edema and autoantibodies were determined in these patients. A treat-to-target strategy initiated with synthetic DMARDs was employed for 12 months. If the patients achieved simplified disease activity index (SDAI) remission along with a reduction of the RA MRI scoring bone edema score to <33% as compared with baseline at 12 months, DMARD treatment was stopped and the clinical status was further observed for the following 12 months. Synthetic DMARDs were stopped at 12 months in 5 patients. One of the 5 was lost to follow-up because of sustaining an injury that required orthopedic surgery. Three of the remaining 4 patients showed continued SDAI remission that was DMARD-free without any evidence of radiographic progression for the following 12 months. Although this was a small clinical trial, we have shown-for the first time-that true remission of very early RA with poor prognosis factors can be achieved by treatment with synthetic DMARDs.

Key words

Very early RA - Synthetic DMARDs - SDAI - Remission - RAMRIS bone edema score