No abstract

Objective. To explore the impact of an early treatment response on maintenance of work capacity in patients with early, active rheumatoid arthritis (RA).Methods. In the Finnish Rheumatoid Arthritis Combination Therapy trial, 195 patients with recentonset RA were randomized to receive either a combination of disease-modifying antirheumatic drugs (DMARDs) with prednisolone or a single DMARD with or without prednisolone for 2 years. Treatment responses were evaluated according to the American College of Rheumatology (ACR) criteria. After a 5-year followup, the cumulative number of days of sick leave and RA-related permanent work disability was calculated for each of the 162 patients who were available for the active work force at baseline. Results.Of the 159 patients assessed at 6 months, 29 were in clinical remission, 66 achieved an ACR50 response but not remission, 29 achieved an ACR20 response but not an ACR50 response, and 35 failed to achieve an ACR20 response. In these 4 groups, the median numbers of work disability days per patientyear from 6 months through 60 months of followup were 0 (interquartile range [IQR] 0-3), 4 (IQR 0-131), 16 (IQR 0-170), and 352 (16-365), respectively (P < 0.001). Pairwise multiple comparisons showed a statistically significant difference between all groups except the ACR50 and ACR20 groups. At 12 months, 30 patients were in remission. None of the 44 patients in remission at 6 or 12 months became permanently work disabled over the 5-year followup, as compared with 15 patients in the ACR50 group (23%), 6 in the ACR20 group (21%), and 19 without an ACR20 response at 6 months (56%).Conclusion. Prompt induction of remission translates into maintenance of work capacity. At 6 months, an ACR50 response is no better than an ACR20 response with regard to future productivity, while failure to achieve an ACR20 response carries a high risk for work disability.

Objective. To investigate the outcome of early rheumatoid arthritis (RA) when treated according to the “sawtooth” strategy, and to compare the results with the findings of other studies. Methods. In this prospective study, 142 patients with early RA were treated actively with slow‐acting antirheumatic drugs (SAARDs) for an average of 6.2 years, and were closely monitored clinically. Several outcome measures were applied, and the results were compared with findings in previously described cohorts. Results. The mean cumulative number of SAARDs used during the study was 3.3. Treatment changes were made because of inefficacy more often than because of adverse events. The percentage of patients whose disease entered remission increased with time to 32% (45 of 142). Only 24% of the patients (34 of 142) had deterioration to Steinbrocker functional class III or IV. The “sawtooth” treatment strategy seemed to improve the outcome of the patients with early RA. Conclusion. In the majority of patients with early RA, “sawtooth” therapy remains beneficial for at least 6 years. However, in one‐fourth of the patients, the disease fails to respond to this drug treatment strategy.

Our aim was to assess the prevalence of symptomatic and asymptomatic peripheral occlusive arterial disease ( P O A D ) in 129 consecutive diabetic ( n = 34) and nondiabetic (12 = 95) patients undergoing renal transplantation. The association of pre-existent POAD and complaints of claudication, lower limb amputations, and graft and patient survival were evaluated during a 5-year follow up. A questionnaire on walking capacity, anklelbrachial (ABI) and toehachial (TBI) pressure indices as well as the pulse volume recording (PVR) at the ankle were used to assess resting haemodynamics and the presence of POAD 4 days after the transplantation. Unquestionable ischaemia was encountered in 5 (4 % ) patients all with a history of intermittent claudication and an ABI equal or below 0.77. While using assessment methods not affected by vessel calcification, i.e. toe pressures and PVR damping, a many-fold frequency of arterial disease was observed when compared to previous studies. TBI below 0.65 was found in 11 of diabetic (32 YO) and in 15 of the others ( 16 YO ), and a PVR amplitude below 5 min in 28 of diabetics (82 YO ) and in 34 of non-diabetics (36 YO ). During the 5-year follow up, abnormal TBI and PVR values and diabetes at the time of transplantation were the greatest risk factors for proximal foot amputations. The low TBI levels also indicated a shortened patient survival. However, transplant function was not affected by the presence of abnormal haemodynamic indices at the time of transplantation.