Skip to main content
NCBI home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 1997 Apr;56(4):235–239. doi: 10.1136/ard.56.4.235

Effect of resumption of second line drugs in patients with rheumatoid arthritis that flared up after treatment discontinuation

W ten 1, J Hermans 1, F Breedveld 1, B Dijkmans 1
PMCID: PMC1752349  PMID: 9165995

Abstract

OBJECTIVE—To assess the effect of resumption of second line drugs in patients with rheumatoid arthritis (RA) that flared after treatment discontinuation.
METHODS—RA patients were studied whose RA flared up after discontinuation of second line treatment while being in remission and who received a second course of the drug. Disease activity parameters were prospectively assessed at the time of treatment discontinuation, during the period when the disease flared up, and three months thereafter. Furthermore the medical charts were reviewed at 12 months after treatment resumption.
RESULTS—There were 51 patients included in the study: 25 patients treated with antimalarial drugs, 10 with parenteral gold, four with d-penicillamine, eight with sulphasalazine, two with azathioprine, and two with methotrexate. Disease activity parameters showed significant improvement within three months of treatment resumption, but remained significantly worse when compared with that measured before treatment discontinuation. Within three months 47% of the patients fulfilled 20% response criteria. Disease activity 12 months after treatment resumption was considered to be absent in 35%, mild in 43%, and moderate or active in 22% of the patients. In four (8%) patients the resumed treatment was stopped because of lack of efficacy. Side effects were recorded in four patients, which did not result in treatment discontinuation.
CONCLUSIONS—Resumption of second line drugs in RA patients whose disease flared up after discontinuation of treatment is effective and safe in most patients. Half of the patients responded within three months after resumption of the second line drug.



Full Text

The Full Text of this article is available as a PDF (83.8 KB).

Figure 1  .

Figure 1  

Open in a new tab

Flow diagram illustrating patient numbers and percentages at all stages of the placebo controlled treatment discontinuation study13 until the inclusion of 51 patients whose disease flared into the present second line treatment resumption study.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ahern M. J., Hall N. D., Case K., Maddison P. J. D-penicillamine withdrawal in rheumatoid arthritis. Ann Rheum Dis. 1984 Apr;43(2):213–217. doi: 10.1136/ard.43.2.213. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Arnett F. C., Edworthy S. M., Bloch D. A., McShane D. J., Fries J. F., Cooper N. S., Healey L. A., Kaplan S. R., Liang M. H., Luthra H. S. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324. doi: 10.1002/art.1780310302. [DOI] [PubMed] [Google Scholar]
  3. BAGNALL A. W. The value of chloroquine in rheumatoid disease: a four-year study of continuous therapy. Can Med Assoc J. 1957 Aug 1;77(3):182–194. [PMC free article] [PubMed] [Google Scholar]
  4. Cade R., Stein G., Pickering M., Schlein E., Spooner G. Low dose, long-term treatment of rheumatoid arthritis with azathioprine. South Med J. 1976 Apr;69(4):388–392. doi: 10.1097/00007611-197604000-00003. [DOI] [PubMed] [Google Scholar]
  5. De Silva M., Hazleman B. L. Long-term azathioprine in rheumatoid arthritis: a double-blind study. Ann Rheum Dis. 1981 Dec;40(6):560–563. doi: 10.1136/ard.40.6.560. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Evers A. E., Sundstrom W. R. Second course gold therapy in the treatment of rheumatoid arthritis. Arthritis Rheum. 1983 Sep;26(9):1071–1075. doi: 10.1002/art.1780260903. [DOI] [PubMed] [Google Scholar]
  7. Jones E., Jones J. V., Woodbury J. F. Response to sulfasalazine in rheumatoid arthritis: life table analysis of a 5-year followup. J Rheumatol. 1991 Feb;18(2):195–198. [PubMed] [Google Scholar]
  8. Kean W. F., Anastassiades T. P. Long term chrysotherapy: incidence of toxicity and efficacy during sequential time periods. Arthritis Rheum. 1979 May;22(5):495–501. doi: 10.1002/art.1780220509. [DOI] [PubMed] [Google Scholar]
  9. Klinkhoff A. V., Teufel A. The second course of gold. J Rheumatol. 1995 Sep;22(9):1655–1656. [PubMed] [Google Scholar]
  10. Kremer J. M., Rynes R. I., Bartholomew L. E. Severe flare of rheumatoid arthritis after discontinuation of long-term methotrexate therapy. Double-blind study. Am J Med. 1987 Apr;82(4):781–786. doi: 10.1016/0002-9343(87)90015-5. [DOI] [PubMed] [Google Scholar]
  11. Paulus H. E., Egger M. J., Ward J. R., Williams H. J. Analysis of improvement in individual rheumatoid arthritis patients treated with disease-modifying antirheumatic drugs, based on the findings in patients treated with placebo. The Cooperative Systematic Studies of Rheumatic Diseases Group. Arthritis Rheum. 1990 Apr;33(4):477–484. doi: 10.1002/art.1780330403. [DOI] [PubMed] [Google Scholar]
  12. Pinals R. S., Masi A. T., Larsen R. A. Preliminary criteria for clinical remission in rheumatoid arthritis. Arthritis Rheum. 1981 Oct;24(10):1308–1315. doi: 10.1002/art.1780241012. [DOI] [PubMed] [Google Scholar]
  13. Ritchie D. M., Boyle J. A., McInnes J. M., Jasani M. K., Dalakos T. G., Grieveson P., Buchanan W. W. Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Q J Med. 1968 Jul;37(147):393–406. [PubMed] [Google Scholar]
  14. Sagransky D. M., Greenwald R. A. Efficacy and toxicity of retreatment with gold salts: a retrospective review of 25 cases. J Rheumatol. 1980 Jul-Aug;7(4):474–478. [PubMed] [Google Scholar]
  15. Szanto E. Low-dose methotrexate in rheumatoid arthritis: effect and tolerance. An open trial and a double-blind randomized study. Scand J Rheumatol. 1986;15(2):97–102. doi: 10.3109/03009748609102072. [DOI] [PubMed] [Google Scholar]
  16. ten Wolde S., Breedveld F. C., Hermans J., Vandenbroucke J. P., van de Laar M. A., Markusse H. M., Janssen M., van den Brink H. R., Dijkmans B. A. Randomised placebo-controlled study of stopping second-line drugs in rheumatoid arthritis. Lancet. 1996 Feb 10;347(8998):347–352. doi: 10.1016/s0140-6736(96)90535-8. [DOI] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES