Strategies for optimal suppression of rheumatoid arthritis
Kooij, S.M. van der
Citation
Kooij, S. M. van der. (2009, January 22). Strategies for optimal suppression of rheumatoid arthritis. Retrieved from https://hdl.handle.net/1887/13425
Version: Corrected Publisher’s Version
License: Licence agreement concerning inclusion of doctoral thesis in the Institutional Repository of the
University of Leiden
Downloaded from: https://hdl.handle.net/1887/13425
Note: To cite this publication please use the final published version (if
applicable).
,A>NF:MHB=
,A>NF:MHB=
:??><ML :??><ML IHINE:MBHG
;NK=>G O>EHI F>MKB<
I:BG EHG@
PAB<A A:O>
=>LMKN<MBHG MA>
"BLMHKR
.A>
/-
LD>E>MHGL
<HGLBLM>GM G:M>=
>GMBMR L<KB;>=
=>L<KBIMBHG
!>G>K:E
B:@GHLBL
><:NL>
FBFB<
<KBM>KB:
F>KB<:G MA>F K>IHKML K>LNEML HK F:MHB=
:G=
IK>L>GM
.A>
<:NL>
BG IK>L>G<>
MKB;NM>L
<KBM>KB:
<>GMER
?>K>GMB:M>=
.K>:MF>GM
.K>:MF>GM K:M>
MA>
LH?M
=KN@L B<L L>O>K>
:<B=
HIF>GM LRGMA>LBS>=
PHKE=PB=>
=:M>
>KG NLN:EER
GMBKA>NF:MB<
MA>
',L
:@>
=B??>K>GM
<NKK>GM
!HE=
,
MH LBG<>
-NE?:L:E:SBG>
P:L
?:NEMR 5 7
<HF;BG:MBHG
<:<R
#G :;E>
<HKMB<HLM>KHB=L HGLMK:M>=
.A>
O>KLR LRLM>FB<
',L
KHF PBMA
<:NL>
F:MB<
.A>
MA>
H?
MABHIKBG>
HIKBG>
>?<:<R
.A>
>?<:<R
<R<EHLIHKBG>
HMK>Q:M>
#G 5 7 ENLMK:M>=
HMA>K MNK:E F@P>>D :M>
@:BGLM BG
&>NGHFB=>
BG
>?<:<R
.(
?:<MHK CHBGM A>K:E=>=
@:M>=
BGBQBF:;
BFIK>LLBO>ER BG@ ≤
57
;>G>M BGBQBF:;
PBMA
)MA>K ANF:G BS>=
<EBGB<:E BG HMK>Q:M>
MK>:MF>GM MK:=BMBHG:E KBHK
=:F:@>
PBMA I:MB>GML HMK>Q:M>
IK>LLBO>
;R 5 7 .A>
:II>:KL BG@
MBHGL
?KHF H?
HMA>K :M
<HNGMKB>L MH M>G :
(>P
:;HNM
PBMABG :GMB;H=B>L
<HGMBGNHNL
#G
=KN@L
@KHNI IKH<>LL :;:M:<>IM MK>:MF>GM .H<BEBSNF:;
MA>L>
MA>
.K>:MF>GM
NKBG@
:<AB>O>=
/GMBE
IRK:FB=
LN<A CHBGM
FBE=>LM
LN:E
KHNG=
L:PMHHMA
K><H@GBS>=
?NG<MBHG:E :II>:K>=
<HGMBGN>=
;>BG@
:G=
IKH@K>LLBHG
.A>
:IIKH:<A
=:F:@>
:G
:=CNLMF>GML
KHNMBG>
.A>L>
FBLLBHG
BG:FF:MBHG
A:IM>K MB>GML IN;EBLA>=
EBGB<:E
.A>
;R MKB:EL :<MBOBMR .A>
#G=>Q P>EE;>BG@
:G=
?HEEHPBG@
-
.H NLBG@
H?≤ LAHPG MBHGL
<HGMBGN:MBHG
?HK<>
BL MK>:MF>GM
.H G:BK>
+N>LMBHGG:BK>
<HGMBGNHNL
<HGLB=>K>=
MH
.A>
BGLMKNF>GM BG<EN=>L Table 1. European League Against Rheumatism response criteria based on the disease activity score (DAS).
DAS at endpoint Improvement 1.2 Improvement ≤1.2 and 0.6 Improvement ≤0.6
≤ 2.4 Good response Moderate response No response
2.4 and ≤ 3.7 Moderate response Moderate response No response
3.7 Moderate response No response No response
F>GML :K>
MA>
?NG<MBHG:E
,
MA>
MBHGBG@
-AHKM E:M>=
*-
L>KO>=
,:=BH@K:IAB<
->O>K:E :=:RL
">BC=>
MH CHBGM
">BC=>
=>O>EHI BL MA>
L<HK>
=:F:@>
<:G L<HK>
I:MB>GML
-
=N>
BG
>KHLBHGL
#G=BOB=N:EBS>=
,>LIHGL>L
>Q:FIE>
:M>
HMK>Q:M>
K>LIHGL>
MB>=
?HK
@>G>MB<L K>LIHGL>
BGN>G<>
.A>
1BMA MBHG .H
?KHF LM>IL GRF
;R ,>L>:K<A BG@
LM>INI MA>K:IR
MB>GML JN>GM
>O>KR ≤
<:E<NE:M>=
MA>
MA>K:IR
≤ : R>:KER :G=
NKBG@
IR
>:KEB>K I:MB>GML :<AB>O>
LMKBOBG@
?HEEHPNI
>@R ≤ HNM
=KBO>G K:=BHEH@B<:E K:=BH@K:IAB<
MH
I:MB>GML
M:I>K
LBHG
LBHG
MK>:MF>GM
:L
)NMEBG>
.ABL K><>GM K>FBLLBHG M:GM
<:E MBHG:E
>-M MA>
=BOB=N:E
=B??>K>GM
=B??>K>GM BG JN:EBMR L>GM>=
LBHG B>
?:BEBG@
:KMAKBMBL
MABL
E>G<>
HEE>@>
-=EAF
JN:EBMR :G=
MBHGLABI
?NG<MBHG:E MBL
HNM<HF>
PBMA MBL
:G=
MHB=
MHB=
<HF>
R>:KL
K>FBLLBHG :KMAKBMBL
LBO>
E:;:F:
=BL>:L>
=>
IKBFBMBO>
:KMAKBMBL
KA>NF:MB<
,A>NF:MBLF LB<:MBHG
KA>NF:MHB=
NMH:GMB;H=B>L IKH@K>LLBHG NG=B??>K>GMB:M>=
JL@JALAK
KB:
AK
IK>=B<MBHG HGL>M MK>:MF>GM
BG
L:EML
;L9
KA>NF:MHB=
KA>NF:MHB=
KA>NF:MHB=
MKB:E
<HFI:KBLHG HMK>Q:M>
>:KER
BLHG
>:KER MKB:E
F:MHB=
:G=
F>=B<:MBHGL
MHB=
F>MAHMK>Q:M>
MAK>>
=HN;E>;EBG=
:IR MA:G MBL
?KHF
FF
MA>K:IR
<HGMKHEE>=
IA:L:E:SBG>
<HFIHG>GML
LNEIA:L:E:SBG>
IHG>GML MKHEE>=
:=K>G:E IHNG=
KA>NF:MHB=
HB=L E9LGD
<HB=L
G;@J9F=
>M :<MBO>
?RBG@
;EBG=
<HGMKHEE>=
>:L>
,@=ME
KA>NF:MHB=
?HK
'>MAHMK>Q:M>
KA>NF:MHB=
=HN;E>;EBG=
MHB=
<R<EHLIHKBG :KMAKBMBL
PBMA :KMAKBMBL -MN=R
=HL>
LHG MK>:MF>GM MKB:E
,>?>K>G<>L
=>I>G=>GM :GMBKA>NF:MB<
MBHG:E
F>GM I:MB>GML
=KN@L
:<MBG@
R>:K
$
F:MHB=
:G=
#GO>LMB@:MHKL
*,'#,
;EBG=
FNF:;
:=:EBFNF:;
F:MHB=
MK>:MF>GM
MB<
:M>
KA>NF:MHB=
E>=
E>NGHFB=>
:KMAKBMBL HFBS>=
'=<
MBHG F:MHB=
,@=ME
=KN@
PH
MBHGL
?HK<>
MBHG:E
FF
E>NGHFB=>
:<MBO>
FNEMB<>GMK>
&9F;=L
KA>NF:MHB=
B>L
F:;
:KMAKBMBL
KMAKBMBL '=<
K:=BH@K:IAB<
BFF>=B:M>
HG@HBG@
>:KER
>?<:<R F:MHB=
,@=ME9LGD
HFI:KBLHG
<HF;BG>=
R>:K LMN=R
O>KLNL
:KMAKBMBL
JL@JALAK
<EBGB<:E F:;
;H=R
<HG<HFBM:GM
<HGMKHEE>=
G><M MK>:MF>GM MA>
:G=
;>G>M :M>
BFIKHO>F>GM
MNFHK
<HG<HFBM:GM
LBHGL LMN=B>L
KHLBHGL
??><MBO>G>LL H?
MNFHK
;H=R HNL F>M::G:ERLBL MKHEE>=
?HEEHPBG@
I:MB>GML IK>MBG@
MNFHK
;:<M>KB:E :KMAKBMBL
:KMAKBMBL /-
:GMBKA>NF:MB<
BOBO
EBGB<:E :=:EBFNF:;
<>GMK:MBHGL
EBQBF:;
I:MB>GML
F:;
<HF>
MHK ,@=ME
F>GM
F:MHB=
F:MB<
H?
,@=ME
HMA>K:IR
K:=BH@K:IAB<
KLM
M>KF LBHG ,@=ME
F>GM
<HFI:KBLHG F>GM
K>?>KK:E :GMBKA>NF:MB<
:KMAKBMBL
:IR KA>NF:MHB=
LMK:M>@R .#),
MKB:E
MK>:MF>GM MBL
BG LMK:M>@R
HIF>GM
<EBGB<:E
F>GM ,A>NF:MBLF
HFI:KBLHG ,A>NF:MHEH@R G:MBHG:E ,@=ME
:
F>KB<:G
<KBM>KB:
LGD
LBHG
<:E K>FBLLBHG
HNM<HF>
F>GM
DAF
=B??>K>G<>
I:MB>GML
MHKL BG
:E :E@HKBMAF
=:F:@>
JL@JALAK
BG
'., BG=BOB=N:EBS>=
BFIKHO>F>GM KA>NF:MHB=
'., MHB=
MBL
MA>
A>:EMA L>E><MBHG
':GN:E
#FKLALML=
=:MBHG -
IHINE:MBHGL
-A:KIO:G
MA>
HEH@B<
JL@JALAK
F:MHB=
IKH@K>LLBHG I:MB>GML
,@=ME
K>LIHGL>
KA>NF:MHB=
,A>NF:MHEH@R
:EEHIKHM>BG:L>L I:MB>GML F:;
G><KHLBL I>NMB<
:KMAKBMBL
)P>GJ<
<:<R :KMAKBMBL IABLFL LAK
@>G>MB<
H?
KA>NF:MHB=
>M MK>:MF>GM :KMAKBMBL
JL@JALAK
>M F:MHB=
/L>
:KMAKBMBL :G=
M>KF LMN=R
KA>NF:MHB=
F>MAHMK>Q:M>
IE:<>;H<HGMKHEE>=
KA>NF:MHB=