Combination drug strategy in recent-onset rheumatoid arthritis suppresses collagen I degradation and is associated with retardation of radiological progression.

Abstract

OBJECTIVE:

To assess whether serum C-terminal cross-linking telopeptide of type I collagen (ICTP), a marker of type I collagen degradation, has any additional value in the assessment of treatment effect in patients with early rheumatoid arthritis (RA).

METHODS:

A total of 182 patients were randomized to treatment either with three disease-modifying anti-rheumatic drugs (DMARDs) and low-dose prednisolone (COMBI) or with a single DMARD with or without low-dose prednisolone (SINGLE). We investigated the prognostic value of serum ICTP level for the progression of joint destruction in X-rays (Larsen's score) from baseline to 2 years.

RESULTS:

There was a statistically significant decrease in serum ICTP levels from baseline to 1 year. At 6 months, the serum ICTP level was lower in the COMBI patients compared to that of the SINGLE cases (p = 0.008, after adjustment for baseline ICTP). When grouping the patients according to serum ICTP tertiles at 6 months, there was a statistically significant trend for increasing median change in Larsen score from baseline to 2 years from lowest to highest ICTP tertile in the SINGLE patients [p = 0.008, after adjustment for 28-joint Disease Activity Score (DAS28) score and RF status at baseline], while in the COMBI, the change remained low in all ICTP tertiles.

CONCLUSIONS:

The COMBI strategy for recent-onset RA results in early suppression of type I collagen degradation, which is reflected in radiological joint damage at 2 years. Serum ICTP at 6 months may be useful for identifying those RA patients whose treatment should be intensified to prevent further joint damage.

• Authors: M Hakala, J Risteli, S Aman, H Kautiainen, M Korpela, P Hannonen, M Leirisalo-Repo, L Laasonen, L Paimela, T Möttönen, Fin-Raco Trial Group
• Journal: Scandinavian journal of rheumatology (Scand J Rheumatol) 2008 Mar-Apr Vol. 37 Issue 2 Pg. 90-3 ISSN: 0300-9742 [Print] England
• PMID: 18415764 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antirheumatic Agents
• Biomarkers
• Collagen Type I
• Peptides
• collagen type I trimeric cross-linked peptide
• Prednisolone

Topics

• Adult
• Antirheumatic Agents (therapeutic use)
• Arthritis, Rheumatoid (blood, drug therapy, physiopathology)
• Arthrography
• Biomarkers (blood)
• Collagen Type I (blood)
• Disease Progression
• Dose-Response Relationship, Drug
• Drug Therapy, Combination
• Female
• Humans
• Joints (physiopathology)
• Male
• Middle Aged
• Peptides (blood)
• Prednisolone (therapeutic use)
• Severity of Illness Index