Aggressive combination therapy with intraarticular glucocorticoid injections and conventional DMARDs in early rheumatoid arthritis Two Year Clinical and Radiographic Results From The CIMESTRA Study.

Merete Hetland; Kristian Stengaard-Pedersen; Peter Junker; Tine Lottenburger; Lis Smedegaard Andersen; Ib Hansen; Ulrik Tarp; Anders Svendsen; Jens K Pedersen; Henrik Skjødt; Ulrik Birk Lauridsen; Torkell Ellingsen; Gert van Overeem Hansen; Hanne Lindegaard; Aage Vestergaard; Anne Grethe Jurik; Mikkel Ostergaard; Kim Hørslev-Petersen; Merete Lund Hetland; Mikkel Ostergaard

doi:http://dx.doi.org/10.1136/ard.2007.076307

Aggressive combination therapy with intraarticular glucocorticoid injections and conventional DMARDs in early rheumatoid arthritis Two Year Clinical and Radiographic Results From The CIMESTRA Study.

Merete Hetland, Kristian Stengaard-Pedersen, Peter Junker, Tine Lottenburger, Lis Smedegaard Andersen, Ib Hansen, Ulrik Tarp, Anders Svendsen, Jens K Pedersen, Henrik Skjødt, Ulrik Birk Lauridsen, Torkell Ellingsen, Gert van Overeem Hansen, Hanne Lindegaard, Aage Vestergaard, Anne Grethe Jurik, Mikkel Ostergaard, Kim Hørslev-Petersen, Merete Lund Hetland, Mikkel Ostergaard

100 Citations (Scopus)

Abstract

OBJECTIVE: To investigate whether clinical and radiographic disease control can be achieved and maintained in patients with early, active rheumatoid arthritis (RA) during the 2nd year of aggressive treatment with conventional DMARD and intraarticular corticosteroid. This paper presents the results of the 2nd year of the randomized, controlled double-blind CIMESTRA study. METHODS: 160 patients with early RA (<6 months' duration) were randomized to receive intraarticular betamethasone in any swollen joint in combination with step-up treatment with either methotrexate and placebo-cyclosporine (monotherapy) or methotrexate plus cyclosporine (combination therapy) during the first 76 weeks. At week 68 hydroxychlorochine 200 mg daily was added. From week 76-104 cyclosporine/placebo-cyclosporine was tapered to zero. RESULTS: ACR20, ACR50 and ACR70 were achieved in 88%, 79% and 59% of patients in the combination vs. 72%, 62% and 54% in the monotherapy group (p= 0.03, 0.02 and 0.6 between groups). Patient's global declined from 50 to 12 vs. 52 to 9, 51% and 50% were in DAS-remission, respectively. Mean+/-SD progressions in total Sharp/vdHeijde score were 1.42+/-3.52 and 2.03+/-5.86 in combination and monotherapy groups, respectively (NS). Serum creatinine levels increased by 7% in the combination group (4% in monotherapy), but hypertension was not more prevalent. CONCLUSION: Continuous methotrexate and intraarticular corticosteroid treatment resulted in excellent clinical reponse and disease control at 2 years, and the radiographic erosive progression was minimal. Addition of cyclosporine during the first 76 weeks resulted in significantly better ACR20 and ACR50 responses, but did not have any additional effect on remission rate and radiographic outcome.

Original language	English
Journal	Annals of the Rheumatic Diseases
ISSN	0003-4967
DOIs	https://doi.org/10.1136/ard.2007.076307
Publication status	Published - 2008

Access to Document

http://dx.doi.org/10.1136/ard.2007.076307

Cite this

Hetland, M., Stengaard-Pedersen, K., Junker, P., Lottenburger, T., Andersen, L. S., Hansen, I., Tarp, U., Svendsen, A., Pedersen, J. K., Skjødt, H., Lauridsen, U. B., Ellingsen, T., van Overeem Hansen, G., Lindegaard, H., Vestergaard, A., Jurik, A. G., Ostergaard, M., Hørslev-Petersen, K., Hetland, M. L., & Ostergaard, M. (2008). Aggressive combination therapy with intraarticular glucocorticoid injections and conventional DMARDs in early rheumatoid arthritis Two Year Clinical and Radiographic Results From The CIMESTRA Study. Annals of the Rheumatic Diseases. https://doi.org/10.1136/ard.2007.076307

Aggressive combination therapy with intraarticular glucocorticoid injections and conventional DMARDs in early rheumatoid arthritis Two Year Clinical and Radiographic Results From The CIMESTRA Study. / Hetland, Merete; Stengaard-Pedersen, Kristian; Junker, Peter et al.

In: Annals of the Rheumatic Diseases, 2008.

Research output: Contribution to journal › Journal article › Research › peer-review

Hetland, M, Stengaard-Pedersen, K, Junker, P, Lottenburger, T, Andersen, LS, Hansen, I, Tarp, U, Svendsen, A, Pedersen, JK, Skjødt, H, Lauridsen, UB, Ellingsen, T, van Overeem Hansen, G, Lindegaard, H, Vestergaard, A, Jurik, AG, Ostergaard, M, Hørslev-Petersen, K, Hetland, ML & Ostergaard, M 2008, 'Aggressive combination therapy with intraarticular glucocorticoid injections and conventional DMARDs in early rheumatoid arthritis Two Year Clinical and Radiographic Results From The CIMESTRA Study.', Annals of the Rheumatic Diseases. https://doi.org/10.1136/ard.2007.076307

Hetland M, Stengaard-Pedersen K, Junker P, Lottenburger T, Andersen LS, Hansen I et al. Aggressive combination therapy with intraarticular glucocorticoid injections and conventional DMARDs in early rheumatoid arthritis Two Year Clinical and Radiographic Results From The CIMESTRA Study. Annals of the Rheumatic Diseases. 2008. doi: http://dx.doi.org/10.1136/ard.2007.076307

@article{36eb06972ee9431fa3ee42d612a62ccd,

title = "Aggressive combination therapy with intraarticular glucocorticoid injections and conventional DMARDs in early rheumatoid arthritis Two Year Clinical and Radiographic Results From The CIMESTRA Study.",

abstract = "OBJECTIVE: To investigate whether clinical and radiographic disease control can be achieved and maintained in patients with early, active rheumatoid arthritis (RA) during the 2nd year of aggressive treatment with conventional DMARD and intraarticular corticosteroid. This paper presents the results of the 2nd year of the randomized, controlled double-blind CIMESTRA study. METHODS: 160 patients with early RA (<6 months' duration) were randomized to receive intraarticular betamethasone in any swollen joint in combination with step-up treatment with either methotrexate and placebo-cyclosporine (monotherapy) or methotrexate plus cyclosporine (combination therapy) during the first 76 weeks. At week 68 hydroxychlorochine 200 mg daily was added. From week 76-104 cyclosporine/placebo-cyclosporine was tapered to zero. RESULTS: ACR20, ACR50 and ACR70 were achieved in 88%, 79% and 59% of patients in the combination vs. 72%, 62% and 54% in the monotherapy group (p= 0.03, 0.02 and 0.6 between groups). Patient's global declined from 50 to 12 vs. 52 to 9, 51% and 50% were in DAS-remission, respectively. Mean+/-SD progressions in total Sharp/vdHeijde score were 1.42+/-3.52 and 2.03+/-5.86 in combination and monotherapy groups, respectively (NS). Serum creatinine levels increased by 7% in the combination group (4% in monotherapy), but hypertension was not more prevalent. CONCLUSION: Continuous methotrexate and intraarticular corticosteroid treatment resulted in excellent clinical reponse and disease control at 2 years, and the radiographic erosive progression was minimal. Addition of cyclosporine during the first 76 weeks resulted in significantly better ACR20 and ACR50 responses, but did not have any additional effect on remission rate and radiographic outcome.",

author = "Merete Hetland and Kristian Stengaard-Pedersen and Peter Junker and Tine Lottenburger and Andersen, {Lis Smedegaard} and Ib Hansen and Ulrik Tarp and Anders Svendsen and Pedersen, {Jens K} and Henrik Skj{\o}dt and Lauridsen, {Ulrik Birk} and Torkell Ellingsen and {van Overeem Hansen}, Gert and Hanne Lindegaard and Aage Vestergaard and Jurik, {Anne Grethe} and Mikkel Ostergaard and Kim H{\o}rslev-Petersen and Hetland, {Merete Lund} and Mikkel Ostergaard",

year = "2008",

doi = "http://dx.doi.org/10.1136/ard.2007.076307",

language = "English",

journal = "Annals of the Rheumatic Diseases",

issn = "0003-4967",

publisher = "B M J Group",

}

TY - JOUR

T1 - Aggressive combination therapy with intraarticular glucocorticoid injections and conventional DMARDs in early rheumatoid arthritis Two Year Clinical and Radiographic Results From The CIMESTRA Study.

AU - Hetland, Merete

AU - Stengaard-Pedersen, Kristian

AU - Junker, Peter

AU - Lottenburger, Tine

AU - Andersen, Lis Smedegaard

AU - Hansen, Ib

AU - Tarp, Ulrik

AU - Svendsen, Anders

AU - Pedersen, Jens K

AU - Skjødt, Henrik

AU - Lauridsen, Ulrik Birk

AU - Ellingsen, Torkell

AU - van Overeem Hansen, Gert

AU - Lindegaard, Hanne

AU - Vestergaard, Aage

AU - Jurik, Anne Grethe

AU - Ostergaard, Mikkel

AU - Hørslev-Petersen, Kim

AU - Hetland, Merete Lund

AU - Ostergaard, Mikkel

PY - 2008

Y1 - 2008

N2 - OBJECTIVE: To investigate whether clinical and radiographic disease control can be achieved and maintained in patients with early, active rheumatoid arthritis (RA) during the 2nd year of aggressive treatment with conventional DMARD and intraarticular corticosteroid. This paper presents the results of the 2nd year of the randomized, controlled double-blind CIMESTRA study. METHODS: 160 patients with early RA (<6 months' duration) were randomized to receive intraarticular betamethasone in any swollen joint in combination with step-up treatment with either methotrexate and placebo-cyclosporine (monotherapy) or methotrexate plus cyclosporine (combination therapy) during the first 76 weeks. At week 68 hydroxychlorochine 200 mg daily was added. From week 76-104 cyclosporine/placebo-cyclosporine was tapered to zero. RESULTS: ACR20, ACR50 and ACR70 were achieved in 88%, 79% and 59% of patients in the combination vs. 72%, 62% and 54% in the monotherapy group (p= 0.03, 0.02 and 0.6 between groups). Patient's global declined from 50 to 12 vs. 52 to 9, 51% and 50% were in DAS-remission, respectively. Mean+/-SD progressions in total Sharp/vdHeijde score were 1.42+/-3.52 and 2.03+/-5.86 in combination and monotherapy groups, respectively (NS). Serum creatinine levels increased by 7% in the combination group (4% in monotherapy), but hypertension was not more prevalent. CONCLUSION: Continuous methotrexate and intraarticular corticosteroid treatment resulted in excellent clinical reponse and disease control at 2 years, and the radiographic erosive progression was minimal. Addition of cyclosporine during the first 76 weeks resulted in significantly better ACR20 and ACR50 responses, but did not have any additional effect on remission rate and radiographic outcome.

AB - OBJECTIVE: To investigate whether clinical and radiographic disease control can be achieved and maintained in patients with early, active rheumatoid arthritis (RA) during the 2nd year of aggressive treatment with conventional DMARD and intraarticular corticosteroid. This paper presents the results of the 2nd year of the randomized, controlled double-blind CIMESTRA study. METHODS: 160 patients with early RA (<6 months' duration) were randomized to receive intraarticular betamethasone in any swollen joint in combination with step-up treatment with either methotrexate and placebo-cyclosporine (monotherapy) or methotrexate plus cyclosporine (combination therapy) during the first 76 weeks. At week 68 hydroxychlorochine 200 mg daily was added. From week 76-104 cyclosporine/placebo-cyclosporine was tapered to zero. RESULTS: ACR20, ACR50 and ACR70 were achieved in 88%, 79% and 59% of patients in the combination vs. 72%, 62% and 54% in the monotherapy group (p= 0.03, 0.02 and 0.6 between groups). Patient's global declined from 50 to 12 vs. 52 to 9, 51% and 50% were in DAS-remission, respectively. Mean+/-SD progressions in total Sharp/vdHeijde score were 1.42+/-3.52 and 2.03+/-5.86 in combination and monotherapy groups, respectively (NS). Serum creatinine levels increased by 7% in the combination group (4% in monotherapy), but hypertension was not more prevalent. CONCLUSION: Continuous methotrexate and intraarticular corticosteroid treatment resulted in excellent clinical reponse and disease control at 2 years, and the radiographic erosive progression was minimal. Addition of cyclosporine during the first 76 weeks resulted in significantly better ACR20 and ACR50 responses, but did not have any additional effect on remission rate and radiographic outcome.

U2 - http://dx.doi.org/10.1136/ard.2007.076307

DO - http://dx.doi.org/10.1136/ard.2007.076307

M3 - Journal article

SN - 0003-4967

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

ER -

Aggressive combination therapy with intraarticular glucocorticoid injections and conventional DMARDs in early rheumatoid arthritis Two Year Clinical and Radiographic Results From The CIMESTRA Study.

Abstract

Access to Document

Fingerprint

Cite this