BeSt, BehandelStrategieën in Reumatoïde Artritis.

Initial treatment with a combination of antirheumatic drugs including either a tapered high dose of prednisone or infliximab, results in earlier and better improvement in functional ability and in statistically significant less progression in joint damage, and not more side effects than initial treatment with monotherapy (either switching to or adding other medication if DAS remains to high).
After 2 years, functional ability in all groups is comparable. This required multiple changes in treatment in the patients in the initial monotherapy groups, whereas many patients in the initial combination groups had been able to taper medication to a single drug maintainance dose. Overall, 42% of all patients reached clinical remission.

There is a clinically and statistically significant difference in functional ability and progression of radiological joint damage after two years of follow-up in patients with early RA who receive initial combination therapy, combination therapy after failure of optimal treatment with MTX, or initial therapy with a TNFa-blocking agent, compared to those receiving combination therapy after intensive treatment with the most effective consecutive single DMARDs.

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Treatment or RA with established antirheumatic medication according to 4 different, accepted strategies.
Treatment adjustments made on the basis of threemonthly measurements of DAS (or on occurrence of side effects).

All patients are treated aggressively, aiming at low disease activity, based on threemonthly calculations of a Disease Activity Score (DAS).
In all four strategy groups the medication is increased or altered if the DAS is 2.4 or higher, or, if the DAS is less than 2.4 for at least 6 months, tapered to a single drug maintainance dose.
All medication steps are dictated by a strategy specific pharmacoprotocol.
The DAS is calculated by a trained research nurse who remains blinded for the treatment that patients receive.