Long-Term Outcomes in Puerto Ricans with Rheumatoid Arthritis (RA) Receiving Early Treatment with Disease-Modifying Anti-Rheumatic Drugs using the American College of Rheumatology Definition of Early RA

Noemí Varela-Rosario1, Mariangelí Arroyo-Ávila1, Ruth M. Fred-Jiménez1, Leyda M. Díaz-Correa1, Naydi Pérez-Ríos2, Noelia Rodríguez1, Grissel Ríos1, Luis M. Vilá1, *
1 Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
2 Puerto Rico Clinical and Translational Research Center, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico

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Creative Commons License
© 2017 Varela-Rosario et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Luis M. Vilá, MD, Chief and Program Director, Division of Rheumatology, University of Puerto Rico Medical Sciences Campus; PO Box 365067; San Juan; PR 00936-5067; Tel: 787-758-2525, ext. 1825; Fax: 787-764-6839; E-mail:



Early treatment of rheumatoid arthritis (RA) results in better long-term outcomes. However, the optimal therapeutic window has not been clearly established.


To determine the clinical outcome of Puerto Ricans with RA receiving early treatment with conventional and/or biologic disease-modifying anti-rheumatic drugs (DMARDs) based on the American College of Rheumatology (ACR) definition of early RA.


A cross-sectional study was performed in a cohort of Puerto Ricans with RA. Demographic features, clinical manifestations, disease activity, functional status, and pharmacotherapy were determined. Early treatment was defined as the initiation of DMARDs (conventional and/or biologic) in less than 6 months from the onset of symptoms attributable to RA. Patients who received early (< 6months) and late (≥6 months) treatments were compared using bivariate and multivariate analyses.


The cohort comprised 387 RA patients. The mean age at study visit was 56.0 years. The mean disease duration was 14.9 years and 337 (87.0%) patients were women. One hundred and twenty one (31.3%) patients received early treatment. In the multivariate analysis adjusted for age and sex, early treatment was associated with better functional status, lower probability of joint deformities, intra-articular injections and joint replacement surgeries, and lower scores in the physician’s assessments of global health, functional impairment and physical damage of patients.


Using the ACR definition of early RA, this group of patients treated with DMARDs within 6 months of disease had better long-term outcomes with less physical damage and functional impairment.

Keywords: Rheumatoid arthritis, Early Treatment, Disease-Modifying anti-rheumatic drugs, Clinical Outcome, Hispanics, Puerto Ricans.