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Related Experiment Video

Updated: Feb 22, 2026

BEST: Barcode Enabled Sequencing of Tetrads

BEST: Barcode Enabled Sequencing of Tetrads

Published on: May 1, 2014

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

Summary

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.

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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.