Evidence map›Paper›PMID 28962586›Full record

Observational studyArthritis research & therapy2017

Further Treatment Intensification in Undifferentiated and Rheumatoid Arthritis Patients Already in Low Disease Activity has Limited Benefit towards Physical Functioning.

Sytske Anne Bergstra, Otto Olivas, Gülşah Akdemir, Naghmeh Riyazi, Gerard Collée, Johannes H L M van Groenendael, Robert B M Landewé, Cornelia F Allaart

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Arthritis research & therapy, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Sytske Anne BergstraDepartment of Rheumatology, Leiden University Medical Centre, C1-R, Postbox 9600, 2300 RC, Leiden, The Netherlands. s.a.bergstra@lumc.nl.ORCID http://orcid.org/0000-0002-7136-5248
Otto OlivasHospital Universitario 12 de Octubre, Madrid, Spain.
Gülşah AkdemirDepartment of Rheumatology, Leiden University Medical Centre, C1-R, Postbox 9600, 2300 RC, Leiden, The Netherlands.
Naghmeh RiyaziMedical Centre Haaglanden, The Hague, The Netherlands.
Gerard ColléeMedical Centre Haaglanden, The Hague, The Netherlands.
Johannes H L M van GroenendaelReumazorg Southwest Netherlands, Bergen op Zoom, The Netherlands.
Robert B M LandewéAmsterdam Rheumatology & Immunology Centre and Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands.
Cornelia F AllaartDepartment of Rheumatology, Leiden University Medical Centre, C1-R, Postbox 9600, 2300 RC, Leiden, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIt is recommended to optimise treatment as long as a predefined treatment target is not met, but should the aim be remission if patients are in low disease activity (LDA)? The aim of this study was to assess if, in patients with rheumatoid arthritis (RA) or patients with undifferentiated arthritis (UA) with Disease Activity Score (DAS) ≤ 2.4 (LDA), treatment intensification results in better functional ability.

methodsIn the IMPROVED study 610 patients with early RA or UA were treated with methotrexate + tapered high-dose prednisone. After 4 months, patients with DAS ≥ 1.6 were randomised to either of two treatment strategies. Patients with DAS < 1.6 tapered treatment. Over 5 years, patients with DAS ≥ 1.6 required treatment intensification, but protocol violations occurred, which allowed us to test the effect of treatment intensification regardless of subsequent DAS. A linear mixed model was used to test, in patients in LDA, the relationship between treatment intensification and functional ability (Health Assessment Questionnaire [HAQ]) over time.

resultsThe number of patients in LDA per visit ranged from 88 to 146. Per visit, 27-74% of the patients in LDA had treatment intensification. We found a statistically significant effect of treatment intensification on ΔHAQ, corrected for baseline HAQ, age, sex and treatment strategy (β = -0.085, 95% CI -0.13 to -0.044). When ΔDAS was added, the effect of treatment intensification was partly explained by ΔDAS, and the association with HAQ was no longer statistically significant (β = -0.022, 95% CI -0.060 to 0.016). When the interaction between treatment intensification and time in follow-up was added, a statistically significant interaction was found (β = 0.0098, 95% CI 0.0010 to 0.019), indicating lesser improvement in HAQ after treatment intensification if follow-up time increased.

conclusionsFor patients with early RA and patients with UA already in LDA, further treatment intensification aimed at DAS remission does not result in meaningful functional improvement.

trial registrationISRCTN, 11916566 . Registered on 28 December 2006. EudraCT, 2006-006186-16 . Registered on 16 July 2007.

Indexed as

AdultAgedAntirheumatic AgentsArthritis, RheumatoidDrug Therapy, CombinationFemaleHumansMaleMethotrexateMiddle AgedMulticenter Studies as TopicPrednisoneRandomized Controlled Trials as TopicRemission InductionTreatment OutcomeAntirheumatic AgentsMethotrexatePrednisoneEarly rheumatoid arthritisLow disease activityPhysical functioningTreatment

Identifiers

PMID28962586
PMCPMC5622576

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.