Early Rheumatoid Arthritis: Biological vs Conventional Treatment and Work Loss

MedicalResearch.com Interview with:
Jonas Eriksson, PhD-student
Clinical Epidemiology Unit
Karolinska Institutet, T2

Biological vs Conventional Combination Treatment and Work Loss in Early Rheumatoid Arthritis A Randomized Trial

MedicalResearch.com:  What are the main findings of the study?

Answer: The main finding from this study is that in patients with early rheumatoid arthritis and with an insufficient response to methotrexate, addition of biologic (infliximab) or conventional combination therapy (sulfasalazine+hydroxychlorquine) resulted in significant improvements in work ability over 21 months. However, at 21 months, no significant difference could be detected in work ability change between patients randomized to addition of biologic or conventional therapy. When comparing the randomized early rheumatoid arthritis patients to matched general population comparators, the average number of days of work loss did not return to the level of the general population, underscoring the need for more effective treatment strategies and earlier diagnosis.

MedicalResearch.com:  Were any of the findings unexpected?

Answer: In the Swefot trial, patients in the biologic treatment group had improved clinical outcomes after 1 year and better radiographical results after 2 years compared to patients randomized to the conventional treatment group. For this reason, the finding of no difference in work loss change at 21 months between the treatment groups was somewhat unexpected.

MedicalResearch.com:  What should clinicians and patients take away from your report?

Answer: With respect to work loss, our results indicate that before starting biologic therapy in early rheumatoid arthritis methotrexate-resistant patients, other intensive treatment regimens may be considered.

MedicalResearch.com:  What recommendations do you have for future research as a result of this study?

Answer: With work loss as and outcome, which may be more inert to treatment than clinical and radiological outcomes, longer follow-up may be desirable. Better radiographic progression observed in the biologic strategy is calling for future studies to assess work ability in the longer term.


Eriksson JK, Neovius M, Bratt J, et al. Biological vs Conventional Combination Treatment and Work Loss in Early Rheumatoid Arthritis: A Randomized Trial. JAMA Intern Med. 2013;():-. doi:10.1001/jamainternmed.2013.7801.