Early RA Vascular Randomised Controlled Study

Effect of Treat-to-target Strategies Aiming at Remission Compared With Minimal Disease Activity on Arterial Stiffness in Early Rheumatoid Arthritis - a Randomised Controlled Study

To investigate the effect of two tight-control treatment strategies, aiming at 1) 2011 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) definition of remission compare with 2) minimal disease activity (Disease Activity Index in 28 joints [DAS28] <2.6), on arterial stiffness in early rheumatoid arthritis (RA) patients.

To compare the effect of two treatments on arterial stiffness in Early Rheumatoid Arthritis

One hundred RA patients with active disease (DAS28 >/=3.2), duration of symptoms less than 2 years, and are disease modifying anti-rheumatic drug naive will participate in this 5-year prospective, hospital-based, open-label, randomized, controlled trial.

All participants will receive 1-year tight-control treatment. One hundred patients will be randomly assigned to two arms. Treatment will be adjusted according to a standardized protocol every 3-monthly aiming at remission defined by the 2011 ACR/EULAR definition (Group 1, n=50, simplified disease activity score [SDAI] ≤3.3) or minimal disease activity (Group 2, n=50, DAS28<2.6). A follow up visit will be conducted at the 5th year to evulate long term effect on vascular outcomes between the two groups.

Inclusion Criteria:

• fulfilled the 2010 ACR/EULAR classification criteria for RA
• have symptoms onset of less than 2 years
• have active disease (DAS28> 3.2)
• are positive for rheumatoid factor or anti-cyclic citrullinated protein antibodies

Exclusion Criteria:

• have a history of overt cardiovascular diseases
• are on aspirin, or HMG-CoA reductase inhibitors (statins) or angiotensin-converting-enzyme inhibitor (ACEI)
• have severe renal impairment defined as a glomerular filtration rate of less than 30 ml/min/1.73m2
• have been previously treated with tumor necrosis factor alpha (TNFa) inhibitors or other biological DMARDs
• on glucocorticoids at a dose >10mg/day