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Patients with rheumatoid arthritis benefit from early 2nd line therapy: 5 year followup of a prospective double blind placebo controlled study.

OBJECTIVE
To compare 2 treatment strategies in a prospective 5 year study of patients with rheumatoid arthritis (RA): early treatment with slow acting antirheumatic drugs (SAARD) versus a "wait and see" attitude.


METHODS
One hundred thirty-seven patients with RA of < 2 years' duration entered a double blind placebo controlled study: patients in the "early" (E) group were treated with auranofin within one year of diagnosis of RA, and SAARD treatment in the initially placebo treated group was delayed 8 months compared with the former group. [The results after 2 years clearly favored early treatment (Borg G, Allander E, Lund B, et al: J Rheumatol 1988; 15:1747-54)].


RESULTS
After a total observation period of 5 years in 75 representative patients, continued improvement in the E group was demonstrated, and differences between the 2 groups were maintained with regard to clinical variables, outcome measures, and radiographic evaluation.


CONCLUSION
The results indicate the existence of a therapeutic window in RA within the first 2 years of the disease.