PMID- 30886952
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220408
IS  - 2520-1026 (Electronic)
IS  - 2520-1026 (Linking)
VI  - 2
DP  - 2018
TI  - Radiographic progression in early rheumatoid arthritis patients following initial 
      combination versus step-up treat-to-target therapy in daily clinical practice: 
      results from the DREAM registry.
PG  - 1
LID - 10.1186/s41927-018-0009-8 [doi]
LID - 1
AB  - BACKGROUND: Early and intensive targeted treatment with disease modifying 
      anti-rheumatic drugs (DMARDs) has been shown to lead to substantial reductions in 
      disease activity and radiograph damage in patients with early rheumatoid 
      arthritis (RA). The aim of this quasi-experimental study was to compare the 
      first-year radiographic progression rates between a treat-to-target (T2 T) 
      strategy with initial combination therapy (strategy II, started in 2012) versus 
      an initial step-up monotherapy (strategy I, started in 2006). METHODS: A total of 
      128 patients from strategy II was individually matched with 128 patients from 
      strategy I on sex, age (+/- 5 yrs.) and baseline disease activity (+/- 0.5 on the 
      DAS28). Differences in radiographic progression (Sharp/van der Heijde) scores 
      (SHS) and the number of patients experiencing a minimal clinically important 
      difference (MCID; >/= 5 SHS points) between both strategies were tested with Mann 
      Whitney U and chi-square tests. Next, linear and logistic regression analyses 
      were performed to examine which baseline variables were associated with 
      radiographic progression scores and the probability of experiencing an MCID 
      within 1 year. RESULTS: Patients with initial combination therapy had slightly 
      higher baseline disease activity scores and pain scores, but better mental health 
      scores. Patients with initial monotherapy had significantly more, and more 
      frequently clinically relevant, radiographic progression after 1 year. 
      Experiencing a MCID was independently associated with fewer tender joints 
      (p = 0.050) and higher erythrocyte sedimentation rate (p = 0.015) at baseline. 
      CONCLUSION: Treating early RA patients with initial combination therapy results 
      in better radiographic outcomes than initial monotherapy in daily clinical 
      practice. TRIAL REGISTRATION: Netherlands Trial Register NTR578, 12 January 2006.
FAU - Steunebrink, Laura M M
AU  - Steunebrink LMM
AUID- ORCID: 0000-0002-7905-5076
AD  - 1Arthritis Center Twente, Department of Rheumatology, Medisch Spectrum Twente, PO 
      BOX 50 000, 7500 KA Enschede, The Netherlands. ISNI: 0000 0004 0399 8347. GRID: 
      grid.415214.7
AD  - 2Department of Psychology, Health & Technology, University of Twente, Enschede, 
      The Netherlands. ISNI: 0000 0004 0399 8953. GRID: grid.6214.1
FAU - Versteeg, Letty G A
AU  - Versteeg LGA
AD  - 1Arthritis Center Twente, Department of Rheumatology, Medisch Spectrum Twente, PO 
      BOX 50 000, 7500 KA Enschede, The Netherlands. ISNI: 0000 0004 0399 8347. GRID: 
      grid.415214.7
AD  - 2Department of Psychology, Health & Technology, University of Twente, Enschede, 
      The Netherlands. ISNI: 0000 0004 0399 8953. GRID: grid.6214.1
FAU - Vonkeman, Harald E
AU  - Vonkeman HE
AD  - 1Arthritis Center Twente, Department of Rheumatology, Medisch Spectrum Twente, PO 
      BOX 50 000, 7500 KA Enschede, The Netherlands. ISNI: 0000 0004 0399 8347. GRID: 
      grid.415214.7
AD  - 2Department of Psychology, Health & Technology, University of Twente, Enschede, 
      The Netherlands. ISNI: 0000 0004 0399 8953. GRID: grid.6214.1
FAU - Ten Klooster, Peter M
AU  - Ten Klooster PM
AD  - 2Department of Psychology, Health & Technology, University of Twente, Enschede, 
      The Netherlands. ISNI: 0000 0004 0399 8953. GRID: grid.6214.1
FAU - Hoekstra, Monique
AU  - Hoekstra M
AD  - Department of Rheumatology, Isala, Zwolle, The Netherlands.
FAU - van de Laar, Mart A F J
AU  - van de Laar MAFJ
AD  - 1Arthritis Center Twente, Department of Rheumatology, Medisch Spectrum Twente, PO 
      BOX 50 000, 7500 KA Enschede, The Netherlands. ISNI: 0000 0004 0399 8347. GRID: 
      grid.415214.7
AD  - 2Department of Psychology, Health & Technology, University of Twente, Enschede, 
      The Netherlands. ISNI: 0000 0004 0399 8953. GRID: grid.6214.1
LA  - eng
PT  - Journal Article
DEP - 20180117
PL  - England
TA  - BMC Rheumatol
JT  - BMC rheumatology
JID - 101738571
PMC - PMC6390778
OTO - NOTNLM
OT  - Early rheumatoid arthritis
OT  - Joint damage
OT  - Radiographic progression
OT  - Remission
OT  - Treat-to-target (T2 T)
COIS- The Medical Ethics Committees of the Medisch Spectrum Twente, Enschede and Isala, 
      Zwolle hospitals determined, in accordance with the 'Medical Research involving 
      Human subjects' act in the Netherlands, that no ethical approval was required 
      because all data were collected in the course of regular daily clinical practice. 
      Nonetheless, patients were fully informed, and prior written informed consent was 
      obtained from each patient.Not applicable.There was no involvement of study 
      sponsors, none of the authors have financial, commercial, or other associations 
      that might pose a conflict of interest in connection with the work.Springer 
      Nature remains neutral with regard to jurisdictional claims in published maps and 
      institutional affiliations.
EDAT- 2018/01/17 00:00
MHDA- 2018/01/17 00:01
PMCR- 2018/01/17
CRDT- 2019/03/20 06:00
PHST- 2017/07/11 00:00 [received]
PHST- 2018/01/07 00:00 [accepted]
PHST- 2019/03/20 06:00 [entrez]
PHST- 2018/01/17 00:00 [pubmed]
PHST- 2018/01/17 00:01 [medline]
PHST- 2018/01/17 00:00 [pmc-release]
AID - 9 [pii]
AID - 10.1186/s41927-018-0009-8 [doi]
PST - epublish
SO  - BMC Rheumatol. 2018 Jan 17;2:1. doi: 10.1186/s41927-018-0009-8. eCollection 2018.