EULAR_2009治疗RA指南-解读.pptVIP

* SAT0012 REGAINED REMISSION FOLLOWING RESTART OF TREATMENT AFTER LOSS OF DRUG-FREE REMISSION IN PATIENTS WITH RECENT ONSET RHEUMATOID ARTHRITIS ? N. B. Klarenbeek*1, S. M. van der Kooij1, M. Güler-Yüksel1, J. H. L. M. van Groenendael2, K. H. Han3, P. J. S. M. Kerstens4, T. W. J. Huizinga1, B. A. C. Dijkmans5, C. F. Allaart11Rheumatology, LUMC, Leiden, 2Rheumatology, Franciscus Hospital, Roosendaal, 3Rheumatology, Maasstad Hospital, Rotterdam, 4Rheumatology, JBI, 5Rheumatology, VUMC, Amsterdam, Netherlands Objectives: To determine the severity and duration of an increase in disease activity in patients who have to restart treatment following a period of drug-free remission. Methods: In the BeSt study, 508 recent onset RA-patients were randomized into 4 treatment strategies: 1. sequential monotherapy, 2. step-up combination therapy, 3. initial combination with prednisone, 4. initial combination with infliximab. Treatment adjustments were made aiming at a disease activity score (DAS) ≤2.4. If DAS was ≤2.4 for ≥6 months medication was tapered to a maintenance dose. After 2 years, when DAS was ≤1.6 for ≥6 months on a maintenance dose the last DMARD was tapered and discontinued. If DAS increased to ≥1.6 the last DMARD was immediately reintroduced. Results: During 5 years follow-up, 115 / 508 patients (23%) achieved drug-free remission. Of those 115 patients, 53 (46%) restarted treatment because of a DAS ≥1.6, after a median period of 5 months, 59 (51%) remained in drug-free remission (median duration now 23 months), and 3 (3%) were lost to follow-up. Sixty percent of restarters were positive for both ACPA and RF, which was found to be a risk factor for loss of drug-free remission (OR 6.0, p0.001). At restart of the DMARD monotherapy, the mean DAS was 2.2 (increased from mean DAS 1.1). Mean increase in ESR was 9 mm/hour. Swollen joint count, tender joint count and VAS general health increased (medians) 2, 2, and 15 mm respectively. Of the 53 restarters, 25 (47%) ag