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Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): A randomized, controlled trial
Open accessAbstract
Objective: Several treatment strategies have proven value in the amelioration of rheumatoid arthritis (RA), but the optimal strategy for preventing long‐term joint damage and functional decline is unclear. We undertook this study to compare clinical and radiographic outcomes of 4 different treatment strategies, with intense monitoring in all patients. Methods: In a multicenter, randomized clinical trial, 508 patients were allocated to 1 of 4 treatment strategies: sequential disease‐modifying antirheumatic drug monotherapy (group 1), step‐up combination therapy (group 2), initial combination therapy with tapered high‐dose prednisone (group 3), and initial combination therapy with the tumor necrosis factor antagonist infliximab (group 4). Treatment adjustments were made every 3 months in an effort to obtain low disease activity (a Disease Activity Score in 44 joints of ≤2.4). Results: Initial combination therapy including either prednisone (group 3) or infliximab (group 4) resulted in earlier functional improvement than did sequential monotherapy (group 1) and step‐up combination therapy (group 2), with mean scores at 3 months on the Dutch version of the Health Assessment Questionnaire (D‐HAQ) of 1.0 in groups 1 and 2 and 0.6 in groups 3 and 4 (P < 0.001). After 1 year, mean D‐HAQ scores were 0.7 in groups 1 and 2 and 0.5 in groups 3 and 4 (P = 0.009). The median increases in total Sharp/Van der Heijde radiographic joint score were 2.0, 2.5, 1.0, and 0.5 in groups 1–4, respectively (P < 0.001). There were no significant differences in the number of adverse events and withdrawals between the groups. Conclusion: In patients with early RA, initial combination therapy including either prednisone or infliximab resulted in earlier functional improvement and less radiographic damage after 1 year than did sequential monotherapy or step‐up combination therapy.
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STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT
Martin Bland, J., & Altman, D. (1986) · The Lancet · doi:10.1016/s0140-6736(86)90837-8 · Cited by 47,965
Cited by
Smolen, J. S., Landewé, R., Bijlsma, J., Burmester, G., Chatzidionysiou, K., Dougados, M., Nam, J., Ramiro, S., Voshaar, M., van Vollenhoven, R., et al. (2017) · Annals of the Rheumatic Diseases · doi:10.1136/annrheumdis-2016-210715 · Cited by 2,057
Self-citationClark, M., Colombel, J.-F., Feagan, B. C., Fedorak, R. N., Hanauer, S. B., Kamm, M. A., Mayer, L., Regueiro, C., Rutgeerts, P., Sandborn, W. J., et al. (2007) · Gastroenterology · doi:10.1053/j.gastro.2007.05.006 · Cited by 224
New tools for classification and monitoring of autoimmune diseases
Maecker, H. T., Lindstrom, T. M., Robinson, W. H., Utz, P. J., Hale, M., Boyd, S. D., Shen-Orr, S. S., & Fathman, C. G. (2012) · Nature Reviews Rheumatology · doi:10.1038/nrrheum.2012.66 · Cited by 95
Moore, R. A., Derry, S., McQuay, H. J., Straube, S., Aldington, D., Wiffen, P., Bell, R. F., Kalso, E., & Rowbotham, M. C. (2010) · Pain · doi:10.1016/j.pain.2009.08.007 · Cited by 98
Metadata
- Authors
- Goekoop‐Ruiterman, Y. P. M., De Vries‐Bouwstra, J. K., Allaart, C. F., Van Zeben, D., Kerstens, P. J. S. M., Hazes, J. M. W., Zwinderman, A. H., Ronday, H. K., Han, K. H., Westedt, M. L., Gerards, A. H., Van Groenendael, J. H. L. M., Lems, W. F., Van Krugten, M. V., Breedveld, F. C., & Dijkmans, B. A. C.
- Venue
- Arthritis & Rheumatism
- Publisher
- Wiley
- Published
- 2005-10-28
- Volume
- 52
- Issue
- 11
- Pages
- 3381-3390
- ISSN
- 0004-3591 (ISSN-L)
- 1529-0131
- OpenAlex
- W2156996668
- Cited by
- 1,460
- References
- 1
- FWCI
- 52.39
- Type
- journal article
- Language
- en
- Open access
- green
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- Goekoop‐Ruiterman, Y. P. M., De Vries‐Bouwstra, J. K., Allaart, C. F., Van Zeben, D., Kerstens, P. J. S. M., Hazes, J. M. W., Zwinderman, A. H., Ronday, H. K., Han, K. H., Westedt, M. L., Gerards, A. H., Van Groenendael, J. H. L. M., Lems, W. F., Van Krugten, M. V., Breedveld, F. C., & Dijkmans, B. A. C. (2005). Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): A randomized, controlled trial. Arthritis & Rheumatism. https://doi.org/10.1002/art.21405
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Bibliographic data: Semantic Scholar, OpenAlex, Crossref.
Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.
