Outcome of patients with rheumatoid arthritis treated by step-wise administration of disease-modifying antirheumatic drugs over a 10-year period

Disease-modifying antirheumatic drugs (DMARDs) are expected to relieve polyarthritis, and thereby improve the patient's quality of life and eventually alter the prognosis of rheumatoid arthritis (RA) or the progressive joint destruction caused by it. DMARDs may cause adverse reactions and become less effective over time in some patients. Using changes in disease activity and X-ray findings as indicators, we retrospectively evaluated the long-term results of the step-wise administration of DMARDs in 200 patients with RA. The patients had been treated with gold compounds, SH compounds, and methotrexate, in this order, over a total of 10 years since initially being diagnosed with the disease in its relatively early stages. The step-wise administration of DMARDs had decreased and controlled RA activity and inflammatory response over the 10 years. Although X-ray findings for the wrists worsened over time in most of the patients, no knee or hip joint destruction was observed in patients in whom disease activity had been controlled well for a long period of time. The progression of destruction of major joints can be prevented in cases in which the Lansbury activity index and C-reactive protein are maintained at levels not more than 30% and 1.5 mg/dl, respectively. Since no drugs are now available which specifically prevent the progression of joint destruction, it is important to control RA activity for as long as possible.