Early, intensive treatment of RA provides long-term benefits and may normalise mortality rates — long-term follow-up study

The results of a 23-year, follow-up study presented at the European League Against Rheumatism (EULAR) Annual Congress 2018 suggest early, intensive treatment of rheumatoid arthritis (RA) has long-term benefits including the normalisation of mortality to levels consistent with the general population.

“We know that the adverse effects of rheumatoid arthritis on the body only become truly apparent after more than a decade,” said Prof Robert Landewé, Chairperson of the Scientific Programme Committee, EULAR. “Therefore, it is really interesting to see these data supporting early therapy after such a long period of follow-up.”

Mortality in patients with RA is higher than in the general population. There have been many advances in management which have demonstrated improved morbidity rates, however, evidence of improved mortality rates has remained elusive.

“Our results confirm that early, intensive treatment of rheumatoid arthritis, including use of glucocorticoids, has long-term benefits,” said Prof Maarten Boers, VU University Medical Centre, Amsterdam, The Netherlands (study author).

“Importantly, this study is one of the first to show a normalisation of RA mortality compared to the general population after 23 years of follow-up.”

This prospective study looked at the rate of mortality after 23 years follow-up of the COBRA (COmbinatietherapie Bij Reumatoide Artritis) trial.

In the original study, patients with early RA were treated with sulphasalazine (SSZ) monotherapy or a combination of SSZ, low-dose methotrexate and initially high, step-down prednisolone.

Results demonstrated the combined therapy regimen offered additional disease control over SSZ alone.

In 2010, after 11 years of follow up, another study showed numerically (but not significantly) lower mortality in patients on the combined therapy regimen compared to patients with SSZ monotherapy.