Estimated Pre-diagnosis Radiological Progression: an important tool for studying the effects of early DMARD- therapy in rheumatoid arthritis

Marius C Wick ^1*, Staffan Lindblad ¹, Ruediger J Weiss ², Lars Klareskog ¹ and Ronald F van Vollenhoven ¹

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

^* To whom correspondence should be addressed. E-mail: marius.wick{at}ks.se.

Accepted 26 March 2004

Abstract

Objective: To determine if intra-patient comparisons between pre-diagnosis and subsequent radiological progression could be used to assess the effects of DMARDs in a RA-inception cohort.

Patients and Methods: We analyzed 149 non- randomized newly diagnosed RA patients. Four groups were chosen: 1) patients treated with methotrexate (MTX, n=56), 2) sulfasalazine (SSZ, n=55), 3) and auranofin (AUR, n=19), and 4) a control-group of patients who changed therapy at least twice, representing poor therapy-responders with persistent clinical activity (control, n=19). Radiographs were quantified using Larsen erosion score. Taking the first onset of RA- symptoms as the earliest starting date for radiological damage, the pre-diagnosis rate of radiological progression was calculated and compared to the observed progression rate during the first year after diagnosis while under DMARD-therapy.

Results: The mean disease duration in all patients from onset of symptoms until diagnosis of RA and DMARD-institution was 6.7±4.0 months. The mean baseline Larsen score was 13.2±9.3, resulting in a mean estimated pre-diagnosis progression rate of 23.6±12.4 Larsen score units/year. In the control- and AUR-group, radiological progression after diagnosis was similar to the progression predicted by the pre-diagnosis progression rates. In the patients for whom MTX or SSZ was the first-line therapy, a marked reduction (71% and 73% respectively; p<0.001) in radiographic progression was seen compared to pre- diagnosis progression.

Conclusions: Pre-diagnosis rates of radiological progression can be used quantitatively to obtain important information on the potential efficacy of DMARDs, and indicate that MTX and SSZ, but not AUR, significantly retard radiographic damage in the first year after diagnosis.

Keywords: Estimation, Larsen score, Pre-diagnosis, Radiological Progression

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