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What have we learned from BeSt?

Cornelia F Allaart1, Iris M Markusse1, Willem F Lems1

  • 1Leiden University Medical Center, Netherlands.

Clinical Immunology (Orlando, Fla.)
|September 21, 2017
PubMed
Abstract

Insights

Early treatment and targeting disease activity in rheumatoid arthritis (RA) significantly improve long-term outcomes. This includes better functional ability, suppressed joint damage, and normalized survival rates, making remission achievable.

Area of Science:

  • Rheumatology
  • Clinical Medicine
  • Immunology

Background:

  • Investigating long-term outcomes in rheumatoid arthritis (RA) over the past decade.
  • Assessing the impact of different treatment strategies on RA progression.

Purpose of the Study:

  • To evaluate the effectiveness of various treatment strategies in patients with DMARD-naïve RA.
  • To determine the long-term impact of treatment-to-target approaches on disease activity, functional ability, and radiologic damage.

Main Methods:

  • Randomized trial comparing four treatment strategies: sequential DMARD monotherapy, step-up combination therapy, initial combination therapy with prednisone, and initial combination therapy with infliximab.
  • Treatment guided by a treat-to-target strategy aiming for DAS ≤ 2.4, with assessments every three months.
  • Evaluation of functional ability (HAQ), radiologic damage (Sharp/vanderHeijde Score), and overall survival.

Main Results:

  • Initial combination therapies (prednisone or infliximab) led to earlier clinical improvement.
  • High rates of remission achieved: up to 50% DAS-remission and 29% drug-free remission.
  • Significant suppression of radiologic damage (median 2 SHS points at 10 years) and functional ability near normal (mean HAQ 0.6).
  • No increased mortality observed (SMR 1.16).

Conclusions:

  • Early treatment initiation is crucial for early clinical improvement in RA.
  • A treat-to-target strategy is key for achieving favorable long-term outcomes.
  • Preventing radiologic damage, disability, achieving drug-free remission, and normalized survival are attainable goals in RA management.

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