Identification and treatment of rheumatoid arthritis leads to improved outcomes and even improved rates of drug-free remission. But, with the course of time, the drugs need to be employed as shown in this study following 4 regimens pain score drawing notable inferences.

Pain is one of the major complaints of patients (pts) suffering from RA and the most common motivation for seeking medical help. The most robust quantitative pain measure appears to be a simple 10 cm visual analogue scale (VAS), which can be completed by the patient and scored by a physician very quickly.

To compare the dynamics of pain in 4 different treatment regimens in early (<2-year duration) RA: methotrexate (MTX), leflunomide (LEF) and combinations of MTX with glucocorticoids (GC).

One hundred forty-one pts with early RA (122 women, mean age 51 years, mean disease duration 24 weeks, mean DAS28 5,9; 64% RF-positive, 59% ACCP-positive) were randomized to receive one of the following treatment regimens: methotrexate (MTX, up to 20 mg/week, 35 pts); MTX plus prednisolone (P) 10 mg daily (MTX-P, 34 pts); MTX-P plus methylprednisolone (MP) 1000 mg intravenously on the first day of treatment (MTX-P-MP, 35 pts); leflunomide 20 mg daily (LEF, 37 pts). Duration of the therapy was one year. Pain was assessed by VAS at the day 0 and after the completion of one-year treatment.

At baseline all groups were comparable in their demographic, clinical and radiographic characteristics, including pain scores. At the end of the treatment the pain scores of pts were decreased in all groups significantly (p < 0.05). In the MTX group pain score was reduced by 49%, in MTX-P group by 52.4%, in MTX-P-MP group by 60.1% and LEF group by 62.8%.

In pts with early RA treated by all 4 regimens pain score was decreased significantly. The most pronounced analgesic effect was noted in MTX-P-MP and LEF groups.