COMBINATION-DRUG THERAPY OF SEROPOSITIVE RHEUMATOID-ARTHRITIS

Objective. To determine the longterm morbidity and mortality in a coho rt of 169 patients with seropositive rheumatoid arthritis (RA) treated by a single rheumatologist with remittive agents used in combination. The effectiveness of a regimen combining pulse oral methotrexate, aza thioprine and an antimalarial drug (MAH) was examined in detail. Metho ds. All outpatient visits by patients followed for at least one year a nd up to 18 years (mean 7 years) were abstracted. Remittive antirheuma tic drugs were used in combination to achieve progressive improvement. Univariate and multivariate analyses of the differences between first and last visit results in 9 process or outcome variables were calcula ted for the entire cohort, for those patients receiving or not receivi ng MAH at last visit, and for those patients taking methotrexate but n ot in combination with both azathioprine and an antimalarial. The numb ers of patients in remission (Lansbury articular index zero), and near remission (articular index < 6) were determined for each of these gro ups. A survival curve was calculated. Results. The entire patient coho rt showed improvement in every variable except hemoglobin at the time of the last visit (p < 0.0004). On multivariate analysis MAH patients were improved only in American Rheumatism Association functional class compared to the other groups (p < 0.001). Remission and near remissio n rates overall were 43 and 61%; for MAH patients 45 and 69% (p = n.s. ). Survival was no different from that of the general population. Herp es tester (17 patients) and second attacks of varicella (2 patients) w ere the most striking side effects. Prednisone use was reduced from 34 to 19% of patients and the mean daily dose was lowered from 9.3 to 5. 9 mg. Conclusion. Combination therapy with multiple antirheumatic agen ts successfully controlled joint inflammation in 167 of 169 patients w ith seropositive RA; complete remission was achieved in 43% of patient s. Survival of this patient cohort did not differ from that of the gen eral population.