Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.

Remission Induction Therapy with Methotrexate and Prednisone in Patients with Early Rheumatoid and Undifferentiated Arthritis.

Wevers-de Boer1,  K.V.C., Heimans1,  L., Visser1,  K., Ronday2,  H.K., Molenaar3,  T.H.E., Seys4,  P.E.H., Bijkerk5,  C.

Leiden University Medical Center, Leiden, Netherlands
Haga Hospital, The Hague, Netherlands
Groene Hart Hospital, Gouda, Netherlands
Franciscus Hospital, Roosendaal, Netherlands
Reinier de Graaf Gasthuis, Delft, Netherlands
Bronovo Hospital, The Hague, Netherlands
MCH, The Hague, Netherlands
Admiraal de Ruyter Hospital, Goes


To assess the proportion remission after 4 months of treatment with methotrexate (MTX) and a tapered high dose prednisone in patients with undifferentiated arthritis (UA) and early rheumatoid arthritis (RA). To identify independent predictors for remission.


IMPROVED is a multicenter clinical study in patients with recent onset RA (< 2 years symptoms) and UA, with a baseline Disease Activity Score (DAS) >= 1.6. 610 patients were included, 479 (79%) patients could be classified as RA patients (according to the 2010 criteria), 121 (20%) patients could not (UA). All patients started MTX 25 mg/wk and prednisone 60 mg/day tapered to 7.5 mg/day in 7 weeks, aimed at achieving remission, defined as DAS < 1.6. Percentages remission after four months were compared between RA and UA. Independent predictors for remission were identified using univariate followed by multivariate logistic regression.


At baseline, RA patients had a higher mean DAS (SD) than UA patients (3.34 (0.92) vs 2.70 (0.66), P<0.001), were more often female (70% vs 60%, P=0.05) and ACPA positive (68% vs 3 %, P<0.001) and had more involvement of small joints (100% vs 93%, P<0.001). After 4 months, remission was achieved in 61% of the patients without a difference between RA and UA (61% vs 64%, P=0.51). ACPA positive RA patients achieved more remission (68% vs 51%, P=0.001) compared to ACPA negative RA patients, but had a lower mean baseline DAS (3.20 (0.89) vs 3.64 (0.94), P<0.001). Of the ACPA negative RA patients, those who achieved remission had a shorter median symptom duration than those who did not (13 (8–26) vs 20 weeks (10–31), P=0.02). Independent baseline predictors for remission in all patients were low joint counts, low HAQ, ACPA positivity, male sex, short symptom duration and low Body Mass Index (BMI) (Table).

Table. predictors of remission in the total study population identified with univariate and multivariate regression analysis.

Univariate regressionOdds95% CI
Diagnosis RA0.870.57–1.33
Baseline DAS0.490.40–0.59
Baseline HAQ0.430.32–0.56
Age (years)1.000.99–1.02
Symptom duration (weeks)0.990.99–1.00
Male sex2.231.52–3.27
ACPA positivity1.631.16–2.28
BMI (kg/m2)0.940.90–0.98
Small joints*0.930.90–0.95
Large joints*0.710.65–0.79
Multivariate regression
Small joints*0.960.93–0.99
Large joints*0.800.72–0.90
Baseline HAQ0.630.46–0.88
Symptom duration (weeks)0.990.98–0.99
Male sex2.061.35–3.14
ACPA positivity1.491.01–2.19
BMI (kg/m2)0.940.90–0.98
* Number of swollen and/or tender joints


Remission induction with MTX and a tapered high dose of prednisone results in similarly high remission percentages in RA (61%) and non-RA (64%) patients after four months. Independent predictors for remission in the total study population indicate that early treatment while disease activity is relatively low, might be most effective, even if ACPA is positive and regardless of fulfilling the ACR 2010 criteria.

To cite this abstract, please use the following information:
Wevers-de Boer, K.V.C., Heimans, L., Visser, K., Ronday, H.K., Molenaar, T.H.E., Seys, P.E.H., et al; Remission Induction Therapy with Methotrexate and Prednisone in Patients with Early Rheumatoid and Undifferentiated Arthritis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :440

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