AB0496 T2t with subcutaneous methotrexate in very early rheumatoid arthritis (RA)
Authors: N. Chichasova, G. Imametdiniva, E. Nasonov
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Objectives</h3> Adherence to foundations T2T and education of patients (pts) according to T2T Connect program increase possibility of favourable outcome of RA <h3>Methods</h3> In open prospective 36 months study of efficacy and safety of subcutaneous methotrexate (MT) 74 pts with definite very early RA (ACR/EULAR 2010 were included: mean age was 45,2±15,9, mean duration of RA – 5.2±3.48 months, mean DAS28 – 5.66±1.99 (max 7.06, min 4.44), RF positivity 73% and ACCP positivity 77% of pts. 3 pts had joint erosions. FK II had 43% and III- 53% of pts. Education conducted by program T2T Connect. Initial dose of MT was 15 mg/week, all pts used 5–10 mg/week folic acid and NSAIDs in therapeutically dose according to comorbidities, systemic glucocorticoids (GK) were not prescribed. 72 pts completed 12 months of treatment, 54–24 months, 29–36 months. <h3>Results</h3> In 88% of pts improvement was observed in first 4–5 weeks. After 3 months low disease activity (LDA) was registered in 18 pts, in over pts therapy wasn't corrected in view with clear tendency to decrease of RA activity, intraarticular injection of GK was performed in 3pts. Changes of DAS28 are in the table 1. After 6 months moderate disease activity was in 49% of pts, LDA – in 51%. After 12 months of study in all pts target of treatment was achieved: LDA in 81% of pts and remission (ACR/EULAR 2010 in 19%; after 24 months 57% and 43% respectively, after 36 months – 36% and 64% respectively (18 pts without treatment). The minimal radiographic progression was observed in 18 pts (24%, mean erosion's score 1.63±1.02), that wasn't cause of firm decrease of functional ability in pts. 3 women with remission after 18 and 20 months of treatment with MT became pregnant and gave birth to normal newborns. Withdraw MT because of AE was in 2 pts (flu-syndrome). In 88% of pts improvement was observed in first 4–5 weeks. After 3 months low disease activity (LDA) was registered in 18 pts, in over pts therapy wasn't corrected in view with clear tendency to decrease of RA activity, intraarticular injection of GK was performed in 3pts. Changes of DAS28 are in the table 1. After 6 months moderate disease activity was in 49% of pts, LDA – in 51%. After 12 months of study in all pts target of treatment was achieved: LDA in 81% of pts and remission (ACR/<sup>EULAR 2010</sup> in 19%; after 24 months 57% and 43% respectively, after 36 months – 36% and 64% respectively (18 pts without treatment). The minimal radiographic progression was observed in 18 pts (24%, mean erosion's score 1.63±1.02), that wasn't cause of firm decrease of functional ability in pts. 3 women with remission after 18 and 20 months of treatment with MT became pregnant and gave birth to normal newborns. Withdraw MT because of AE was in 2 pts (flu-syndrome). <h3>Conclusions</h3> Peculiarity of our group of pts was the beginning of the treatment by MT, in most cases, at the first 6 months of RA onset. It is possible in this case to achieve remission more, than in half of pts without GK treatment. Thus, the subcutaneous form of MT is effective as regards activity and progression in early RA, safety for the long time in case of the using principles of controlled treatment allows achieve target after 6–12 month of therapy in most of pts with RA. <h3>Disclosure of Interest</h3> None declared