CONCISE REPORT

Estimated prediagnosis radiological progression: an important tool for studying the effects of early disease modifying antirheumatic drug treatment in rheumatoid arthritis

M C Wick¹, S Lindblad¹, R J Weiss², L Klareskog¹, R F van Vollenhoven¹

¹ Rheumatology Unit, Department of Medicine at Karolinska Hospital, Stockholm, Sweden
² Department of Orthopaedic Surgery, Karolinska Hospital, Stockholm, Sweden

Correspondence to:
Dr M C Wick
Department of Radiology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria; marius.wick{at}uibk.ac.at

Objective: To determine if intrapatient comparisons between prediagnosis and subsequent radiological progression could be used to assess effects of DMARDs in an RA inception cohort.

Patients and methods: 149 non-randomised patients with newly diagnosed RA in four groups were analysed: patients treated with (a) methotrexate (n = 56); (b) sulfasalazine (n = 55); (c) auranofin (n = 19); and (d) controls who were poor treatment responders (n = 19). Radiographs were quantified using the Larsen erosion score. The prediagnosis radiological progression from the onset of RA symptoms to diagnosis was calculated and compared with the observed progression rate during the first year after diagnosis while receiving DMARD treatment.

Results: Mean (SD) disease duration from onset of symptoms until diagnosis was 6.7 (4.0) months. Mean (SD) baseline Larsen score was 13.2 (9.3), giving a mean (SD) estimated prediagnosis progression rate of 23.6 (12.4) Larsen score units/year. Control and auranofin groups showed radiological progression after diagnosis similar to the progression predicted by prediagnosis progression rates. Patients receiving methotrexate or sulfasalazine showed a marked reduction (71% and 73%, respectively; p<0.001) in radiographic progression compared with prediagnosis progression.

Conclusions: Prediagnosis rates of radiological progression can be used quantitatively to obtain information on the potential efficacy of DMARDs, and indicate that methotrexate and sulfasalazine, but not auranofin, significantly retard radiographic damage in the first year after diagnosis.

Abbreviations: AUR, auranofin; CRP, C reactive protein; DAS28, 28 joint Disease Activity Score; DMARD, disease modifying antirheumatic drug; ESR, erythrocyte sedimentation rate; HAQ, Health Assessment Questionnaire; MTX, methotrexate; RA, rheumatoid arthritis; SJC, swollen joint count; SSZ, sulfasalazine; TJC, tender joint count; VAS, visual analogue scale

Keywords: estimation; Larsen score; prediagnosis; radiological progression

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Radstake, T R D J, Svenson, M, Eijsbouts, A M, van den Hoogen, F H J, Enevold, C, van Riel, P L C M, Bendtzen, K (2009). Formation of antibodies against infliximab and adalimumab strongly correlates with functional drug levels and clinical responses in rheumatoid arthritis. Ann Rheum Dis 68: 1739-1745 [Abstract] [Full Text]  
• Finckh, A, Choi, H K, Wolfe, F (2006). Progression of radiographic joint damage in different eras: trends towards milder disease in rheumatoid arthritis are attributable to improved treatment. Ann Rheum Dis 65: 1192-1197 [Abstract] [Full Text]  
• Manfredsdottir, V. F., Vikingsdottir, T., Jonsson, T., Geirsson, A. J., Kjartansson, O., Heimisdottir, M., Sigurdardottir, S. L., Valdimarsson, H., Vikingsson, A. (2006). The effects of tobacco smoking and rheumatoid factor seropositivity on disease activity and joint damage in early rheumatoid arthritis. Rheumatology (Oxford) 45: 734-740 [Abstract] [Full Text]