Conventional monotherapy compared to a "sawtooth" treatment strategy in the radiographic progression of rheumatoid arthritis over the first eight years

Objective To describe the treatment with disease-modifying antirheumatic drugs (DMARD s) in two inception cohorts of rheumatoid arthritis (RA) patients and to co mpare their radiographic outcomes. Methods A recent onset RA cohort was collected in Heinola in 1973-1975, and another in Jyvaskyla in 1983-1989 The cohorts were followed up prospectively and t reated with available DMARDs. The radiographic outcomes of 103 and 85 serop ositive cohort patients from Heinola and Jyvaskyla respectively were assign ed Larsen scores (0 - 100) for their wrist, hand and foot radiographs in ye ars 0 1, 3 and 8 and compared with each other Results In this study it was seen that DMARD treatment for RA became more extensive over time. The earlier cohort patients were treated with gold sodium thiom alate, chloroquine and D-penicillamine, while 8 additional DMARDs and vario us DMARD combinations were used for the later cohort patients. At the 8 yea r visit, 23%, 33%, and 2% of the Heinola patients, and 6%, 45%, and 21% of the Jyvaskyla patients respectively were being treated with chloroquine, ot her single DMARDs, or DMARD combinations. Destruction in the peripheral joi nts remained lower in the more extensively treated cohort; from 0 to 8 year s the median Larsen score increased from 1 to 25.5 and from 0 to 12 (p = 0. 001) for the Heinola and the Jyvaskyla patients, respectively. Conclusion Our result supports a role of DMARDs in preventing joint destruction in RA in the long-term.