Targeted treatment with a combination of traditional DMARDs produces excellent clinical and radiographic long-term outcomes in early rheumatoid arthritis regardless of initial infliximab. The 5-year follow-up results of a randomised clinical trial, the NEO-RACo trial

摘要

The current treatment of rheumatoid arthritis (RA) aims at early and sustained remission.1 A considerable proportion of the patients may achieve this target, even in the long term. Previous trials have shown that in the treatment of early RA a combination of disease modifying antirheumatic drugs (DMARDs) is better than DMARD mono-therapy,that targeted therapy is better than routine care, and that the use of glucocorticoids (GCs) orally, and intra-articularly improves the results. Further, added induction therapy with infliximab (INFL), has, in combination with metho-trexate (MTX), been shown to be more effective than MTX monotherapy,a finding confirmed with other tumour necrosis factor-a (TNF) inhibitors,but comparable early response is achieved with a combination of DMARDs and GCs.When applying targeted strategies, the clinical outcomes of different initial treatments do not differ in the long term,but the early achievement of low disease activity or remission results in lower total radiographic progression and better maintenance of working capacity,emphasising the importance of rapid suppression of inflammation.