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Early versus Delayed Treatment in Patients with Recent-onset Rheumatoid Arthritis: Comparison of Two Cohorts Who Receive PowerPoint Presentation
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Early versus Delayed Treatment in Patients with Recent-onset Rheumatoid Arthritis: Comparison of Two Cohorts Who Received Different Treatment Strategies.

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Early versus Delayed Treatment in Patients with Recent-onset Rheumatoid Arthritis: Comparison of Two Cohorts Who Received Different Treatment Strategies

Lard, L., H. Visser, I. Speyer, I. vander Horst-Bruinsma, A. Zwinderman, F. Breedveld, J. Hazes. 2001. American Journal of Medicine. October: 111(6): 446-451.

Presented by Wislaine Coby

what is rheumatoid arthritis
What is rheumatoid arthritis?
  • An autoimmune disease that causes chronic inflammation of the joints.
  • Two million Americans are affected of all ages.
  • Most common in women
cause
Cause
  • The cause is not known
  • Suspicions of infectious agents such as viruses and bacteria but no proof as the cause.
  • May be genetically inherited
signs and symptoms
Signs and Symptoms
  • Stiffness
  • Pain
  • Swelling
  • Redness
  • Fatigue
diagnosis of definite or probable ra
Diagnosis of Definite or Probable RA
  • Morning stiffness for more the 30 minutes
  • More than five swollen joints
  • Ritchie score greater than 15
  • Erythrocyte sedimentation rate greater than 28 mm/h
other requirements
Other Requirements
  • Radiographic joint damage, measured by modified Sharp score
  • Health assessment questionnaire
  • Modified disease activity score
  • C-reactive protein level
treatment strategies
Treatment Strategies
  • (DMARD) disease modifying antirheumatic drug=helps to slow the progression of the disease
  • (NSAID) nonsteroidal anti-inflammatory drugs=reduces pain and inflammation.

Early treatment:(DMARD) disease modifying antirheumatic drug and (NSAID) nonsteroidal anti-inflammatory drugs (two weeks after)

Delayed treatment:(NSAID) nonsteroidal anti-inflammatory drugs and (DMARD) disease modifying antirheumatic drug (used after several months)

prescribed dose on type of dmard
Prescribed dose on type of DMARD
  • Chloroquine: 300 mg/day for the first month
  • Salazopyrine: 2000 mg/day
results of study
Results of study
  • From 1993 of January to 1995 of December, 109 patients with probable or definite disease were included.
  • From 1996 of January – 1998 of December, 97 patients with arthritis were included.
chart analysis
Chart Analysis
  • Patients in the early treatment group showed very little progression of joint destruction
modified sharp score
Modified Sharp Score
  • Progression of radiographic joint damage was the same at 6 months for both group.
  • Early: stabilized at 3.5
  • Delayed: progressed at 10
median disease activity score c reactive protein level
Median Disease Activity Score/C-reactive Protein Level

•Early treatment showed greater improvement for the mdas;

•Low levels in the Crpl (322) and the mdas (64)

•Delayed had high levels in the Crpl (486) and mdas (73)

C-reactive Protein Level

side effects
Side Effects

Delayed

  • 3patients had to change initial therapy due to side effects
  • First treatment changed because lack of efficacy in 10 patients.
  • 4 patients changed initial therapy without dmard

Early

  • 12 patients changed treatment due to adverse affects
  • 21 patients discontinued treatment due to lack of efficacy.
  • 8 patients changed initial therapy without dmard
conclusion
Conclusion
  • Early treatment is crucial to reduce any symptoms, maximize joint function and prevent joint destruction and deformity.
  • DMAD has very little side effects and is a better drug to treat patients with early RA.