Which of four treatment strategies stands the highest chance to lead to long-term health, decreased pain and improved work ability in rheumatoid arthritis?

The overall aim is to investigate the optimal first-line treatment strategy in new-onset rheumatoid arthritis (RA)with regards to long-term RA-disease control, pain, work ability and health economic outcomes.We base our current proposal on important long-term follow-up investigations of the “NORD-STAR” trial, which isa four-armed randomized trial in early RA comparing initial MTX/prednisolone with addition of TNF-blockade, IL-6blockade and T-cell targeted therapy; with tapering of biologicals after sustained remission (induction-maintenancestrategy).

The here proposed NS-Extension study will aim to answer the research questions:1.

From a patient-outcome point of view, which of these treatment strategies is the most likely to result in longtermremission and decreased pain?2.

From a societal point of view, what are the long-term economic consequences of each strategy, i.e.health care costs, work ability and cost-effectiveness?The NS-Extension study will include follow-up of RA patients earlier followed in NORD-STAR (Population), treatedwith modern RA treatments (Intervention) compared to conventional treatment (Control) to achieve long-termremission (Primary Outcome) and improved pain, work ability (secondary outcomes).The current proposal has very good potential to answer the most important questions in RA treatment of today,worldwide, and the results can be expected to have vital importance on future treatment strategies in Sweden and in an international perspective.