OP0012 BENEFIT OF VERY EARLY REFERRAL AND THERAPY WITH DISEASE MODIFYING ANTIRHEUMATIC DRUGS IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS
V.P.K. Nell, K.P. Machold, G. Eberl, M. Uffmann, T. Stamm, J.S. Smolen

The purpose of this study was to test if a "window of opportunity" exists of early intervention for patients with rheumatoid arthritis (RA).

Methods: Twenty patients with very early RA (VERA) with a mean disease duration of 3 months prior to DMARD initiation were compared to a group of 20 age and gender matched patients with late early RA (LERA) with a mean disease duration of 20 months prior to DMARD initiation. Disease activity was measured every 3 months for the first year and yearly thereafter. The disease activity score (DAS) and the Larsen score were used as primary outcome measures.

Results: 45% of the VERA group were rheumatoid factor+ (RF+) at baseline compared to 40% of the LERA patients. Following 3 months of DMARD therapy, significant differences in improvement were noted between the two groups, in both disease activity and functional status, in favor of the VERA group. Below are the measurements at 36 months.

Conclusions: These data indicate that, in spite of similar DMARD therapy, there exists a "window of opportunity" for successful treatment of RA within the first year and particularly, the first 3 months of treatment. Following that time, the slope of improvement is parallel between the 2 groups. The results of this study emphasize the importance of early diagnosis and therapy to control disease progression and prognosis in RA.

Editorial Comment: Several studies have suggested that early treatment of RA, even if that particular treatment is not continued long-term, can have a long-term impact in reduction of rate of disease activity and radiographic progression, compared to patients in whom treatment is delayed. The current study further supports this observation. It will be important to compare, however, the severity of disease of the 2 groups at study entry, as well as their respective treatment regimens.

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