Abstract:
The clinical response to traditional diseasemodifying
anti-rheumatic drugs (DMARDs) in indigent
South Africans with early rheumatoid arthritis was investigated.
A cohort of patients with early (≤2 years) RA who were
DMARD-naïve at inception were prospectively assessed for
response to DMARDs using the Simplified Disease Activity
Index (SDAI) over a 12-month period. Patients with low
disease activity (LDA) at 12 months were compared to those
with moderate and high disease activity with respect to demographic,
clinical, autoantibody and radiographic features. The
171 patients (140 females) had a mean (SD) age of 47.1 (12.4)
years, symptom duration of 11.7 (7.1) months and baseline
SDAI of 39.4 (16.2). There was a significant overall
improvement in the SDAI and its components in the 134
(78.4%) patients who completed the 12 months visit, but only
28.4%of them achieved LDA. The majority of patients (91%)
were treated with methotrexate as monotherapy or in combination
with chloroquine and/or sulphasalazine. Baseline features
that independently predicted a LDA state at 12 months
were lower Health Assessment Questionnaire Disability Index
(p00.023) and a higher haemoglobin level (p00.048). Receiver
operating characteristic curve analysis showed that
the 6-month SDAI was better than the baseline SDAI in
predicting the 12-month SDAI (area under the curve of 0.69
vs. 0.52, respectively, p00.008). In conclusion, less than a
third of the patients achieved a low disease activity at
12 months on traditional DMARDs. Patients who have an
inadequate response to traditional DMARDs at 6 months are
unlikely to show further improvement on traditional
DMARDs at 12 months. These findings underscore the need
for better disease control by an aggressive tight control
strategy, including intense patient education and biologic
therapy.
