Ten years radiographic outcome of rheumafactor positive rheumatoid arthritis patients treated with aggressive low dose immunosuppressive combination therapy.

We observed 10-year radiographic outcomes in patients with rheumatoid factor positive rheumatoid arthritis prospectively. Group I, II, and III comprised 87, 125, and 89 consecutive subjects with disease duration at presentation of less than 4, 4-24, and 25-255 months, respectively. Initial therapy was with combinations of pulse intravenous (i.v.) methylprednisolone (0-125 mg), cyclophosphamide (100-200 mg), methotrexate (MTX, 5-15 i.v. mg/week) and simultaneous oral cyclosporin A (CSA, 25 mg bid/tid). After disease was controlled i.v. therapy was tapered and switched to oral MTX + CSA. Outcomes from the Larsen Index and Erosive Joint Count were compared in cases and in dropouts with baseline and each other. Significant improvement in the Larsen Index and Erosive Joint Count was observed in Group I (p < 0.0001). In Group II and III the improvement or deterioration was not significant. The Larsen Index and Erosive Joint Count deteriorated significantly in the dropouts compared with baseline and cases (p < 0.0001). In conclusion, in early RA, in a Malayo-Polynesian patient sample, radiological progression could be halted with aggressive combination treatment.