Analysis of improvement in individual rheumatoid arthritis patients treated with disease-modifying antirheumatic drugs, based on the findings in patients treated with placebo

Authors

  • Harold E. Paulus MD,

    Corresponding author
    1. Professor of Medicine, Division of Rheumatology, University of California, Los Angeles School of Medicine
    2. Cooperative Systematic Studies of Rheumatic Diseases group.
    • UCLA School of Medicine, Division of Rheumatology, 1000 Veteran Avenue, 32–47, Los Angeles, CA 90024-1670
    Search for more papers by this author
  • Marlene J. Egger PhD,

    1. Associate Professor of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City
    2. Cooperative Systematic Studies of Rheumatic Diseases group.
    Search for more papers by this author
  • John R. Ward MD,

    1. Professor of Medicine, Division of Rheumatology, University of Utah School of Medicine, Salt Lake City
    2. Cooperative Systematic Studies of Rheumatic Diseases group.
    Search for more papers by this author
  • H. James Williams MD

    1. Professor of Medicine, Division of Rheumatology, University of Utah School of Medicine, Salt Lake City
    2. Cooperative Systematic Studies of Rheumatic Diseases group.
    Search for more papers by this author

Abstract

A composite index for estimating improvement in individual rheumatoid arthritis (RA) patients during trials of slow-acting, disease-modifying antirheumatic drugs (DMARDs) was developed by analyzing the responses of 130 placebo-treated participants in Cooperative Systematic Studies of Rheumatic Diseases studies. If responses in 4 of 6 selected measures were required for improvement (by ⩾20% for morning stiffness, Westergren erythrocyte sedimentation rate, joint pain/tenderness score, and joint swelling score, and by ⩾2 grades on a 5-grade scale, or from grade 2 to grade 1 for patient's and physician's overall assessments of current disease severity), few placebo-treated patients qualified as improved, whereas significantly more DMARD-treated patients demonstrated improvement. The proposed index appears to be useful in estimating the probability that an RA patient will improve if taking a placebo during a DMARD trial, and may be a useful tool for analysis of DMARD studies.

Ancillary