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Title: Use of novel prognostic tools, outcome measures and therapeutic strategies in early rheumatoid arthritis
Author: Bejarano, Victoria
ISNI:       0000 0004 2727 1601
Awarding Body: University of Leeds
Current Institution: University of Leeds
Date of Award: 2011
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Though the management of rheumatoid arthritis (RA) has recently been revolutionised, the optimal initial therapeutic regimen in the vital early stages is not known and critically the long-term effects of currently proposed regimens are not well documented. Patients with an expected poor prognosis would gain most from early treatment with highly effective but expensive new therapies; this highlights the need for better prognostic tools. Modern outcomes for RA should reflect patient expectations, for example, participation in work. In this thesis, evidence of the long-term effects of 2 initial therapeutic regimens in early RA was sought. Patients treated with an initial combination of methotrexate (MTX), ciclosporin A (CsA) and intraarticular glucocorticoids in early, poor prognosis RA required less biological agents after 7 years, compared with sulfasalazine (SSZ) monotherapy. The toxicity associated with CsA was reversible. Similarly patients that received an initial combination of infliximab plus MTX for early, poor prognosis RA had better disease control at 8 years than those who had initial MTX monotherapy. Dual energy X-ray absorptiometry (DXA) was tested as a prognostic tool in early RA given its reliability and easy availability. DXA measured hand bone loss during the first year of treatment was associated with radiographic progression at 6 years; however this did not perform better than a baseline radiograph. Imminent and actual job loss were proposed as patient reported outcomes in early RA. Patients receiving an initial combination of adalimumab plus MTX in early RA had a larger improvement in work related outcomes compared with MTX monotherapy. In summary initial therapeutic combinations in early RA can offer short and long-term benefits compared with monotherapy when measuring modern patient relevant and traditional outcomes. There is still a need for clinically useful prognostic tools in early disease.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available