Treatment in the Rotterdam Early Arthritis CoHort. A stratified, randomised clinical trial in patients with recent-onset arthritis.

In patient with recent-onset arthritis treatment strategies will be initiated according to their probability to develop persistent arthritis based on the Visser-model. For each stratum of probability (high probability, intermediate probability(IP), low probability(LP), the efficacy of induction therapy with divergaet intensity will be compared.

If after 3 months a low disease activity (DAS<2.4)is not achieved, patients will receive more intensive treatment including biologicals(initial biological will be etanercept) If a DAS<1.6 is achieved for at lleast 6 months, patients will start to taper and finally stop all medication. Study outcomes after 1 year treatment are:
Functional ability (HAQ) and disease activity score (DAS) over time (area under the curve) and progression of radiological joint damage as measured by Sharp/ van der Heijde score.

In each stratum of probability there is a clinically and statistacally significant difference in the functional ability and disease activity score over time (area under the curve) and progression of radiological joint damage after 1 year of follow-up in recent-onset arthritia patients who were having induction treatment with divergent intansity.

N/A

Three monthly evalutions of disease activity score and safety. Medication adjustments by ptotocol, based on DAS calculations. If DAS.2.4 medication will be switched to more intensive treatment including biologicals (initial biological will be etanersept). If DAS< 1.6 is achieved for at least 6 months, patients will start to taper and finally stop all medication.
Inductiontherapy for the three strata will be;

HP-group:

1. MTX+SSZ+HCQ+1 single dose cortocisteroid intramuscular;

2. MTX+SSZ+HCQ+prednisone;

3. MTX+prednison.

IP-group:

1. MTX;

2. HCQ;

3. Prednisone.

LP-group:

1. Naproxen;

2. HCQ;

3.1 singel dose corticosteroids intramuscular.