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Early combination disease-modifying antirheumatic drug therapy and tight disease control improve long-term radiologic outcome in patients with early rheumatoid arthritis : the 11-year results of the Finnish Rheumatoid Arthritis Combination Therapy trial . INTRODUCTION Early treatment of rheumatoid arthritis ( RA ) has been shown to retard the development of joint damage for a period of up to 5 years . The aim of this study was to evaluate the radiologic progression beyond that time in patients with early RA initially treated with a combination of three disease-modifying antirheumatic drugs ( DMARDs ) or a single DMARD . METHODS A cohort of 199 patients with early active RA were initially randomized to receive treatment with a combination of methotrexate , sulfasalazine , and hydroxychloroquine with prednisolone ( FIN-RACo ) , or treatment with a single DMARD ( initially , sulfasalazine ) with or without prednisolone ( SINGLE ) . After 2 years , the drug-treatment strategy became unrestricted , but still targeted remission . The radiographs of hands and feet were analyzed by using the Larsen score at baseline , 2 , 5 , and 11 years , and the radiographs of large joints , at 11 years . RESULTS Sixty-five patients in the FIN-RACo and 65 in the SINGLE group had radiographs of hands and feet available at baseline and at 11 years . The mean change from baseline to 11 years in Larsen score was 17 ( 95 % CI , 12 to 26 ) in the FIN-RACo group and 27 ( 95 % CI , 22 to 33 ) in the SINGLE group ( P=0.037 ) . In total , 87 % ( 95 % CI , 74 to 94 ) and 72 % ( 95 % CI , 58 to 84 ) of the patients in the FIN-RACo and the SINGLE treatment arms , respectively , had no erosive changes in large joints at 11 years . CONCLUSIONS Targeting to remission with tight clinical controls results in low radiologic progression in most RA patients . Patients treated initially with a combination of DMARDs have less long-term radiologic damage than do those treated initially with DMARD monotherapy . TRIAL REGISTRATION Current Controlled Trials ISRCTN18445519 .
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Intervention_Pharmacological
antirheumatic drug therapy
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Intervention_Pharmacological
three disease-modifying antirheumatic drugs ( DMARDs )
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Intervention_Pharmacological
single DMARD
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Intervention_Pharmacological
methotrexate
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Intervention_Pharmacological
sulfasalazine
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Intervention_Pharmacological
hydroxychloroquine with prednisolone ( FIN-RACo )
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Intervention_Pharmacological
single DMARD ( initially , sulfasalazine )
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Intervention_Pharmacological
prednisolone ( SINGLE )
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Intervention_Pharmacological
FIN-RACo
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Intervention_Pharmacological
SINGLE
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Intervention_Pharmacological
FIN-RACo
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Intervention_Pharmacological
SINGLE
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Intervention_Pharmacological
combination of DMARDs
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Intervention_Physical
DMARD monotherapy
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Outcome_Other
long-term radiologic outcome
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Outcome_Other
evaluate the radiologic progression
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Outcome_Other
radiographs
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Outcome_Physical
analyzed by using the Larsen score
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Outcome_Physical
Larsen score
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Outcome_Physical
erosive changes
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Outcome_Other
radiologic progression
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Outcome_Other
long-term radiologic damage
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Participant_Condition
patients with early rheumatoid arthritis :
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Participant_Condition
rheumatoid arthritis ( RA )
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Participant_Condition
patients with early RA initially treated with a combination of three disease-modifying antirheumatic drugs ( DMARDs ) or a single DMARD .