Background Several prediction models for rapid radiological progression in the first year of treatment have been designed to base the initial treatment choice on.
Objectives To assess whether rapid radiological progression (RRP) has clinical relevance through association with functional disability over 8 years of disease activity steered treatment in early RA patients.
Methods Data of all 465 patients from the BeSt study with radiographs of hands and feet at baseline and after 1 year were used. All were treated according to a disease activity score (DAS) ≤2.4 steered protocol. RRP was defined as an increase in SHS of ≥5 after the first year of treatment. Radiographs of years 0-8 were then scored by 2 different readers, unaware of patient identity and time order, using the Sharp/vd Heijde Score (SHS). Functional ability over 8 years, measured every 3 months with the Health Assessment Questionnaire (HAQ), was compared in patients with and without RRP using linear mixed models, adjusted for treatment group, baseline HAQ, ESR and SHS and rheumatoid factor (RF), anti-citrullinated protein antibody-status (ACPA) or a combination of RF and ACPA. Subsequently, disease activity score (DAS) over time was added to this model. Multivariate logistic regression analyses were performed to assess the association between RRP and joint damage progression in year 1-8.
Results RRP was observed in 102/465 (22%) patients. Patients with RRP were more often treated with initial monotherapy than patients without RRP and more often RF (82% vs. 60%) and ACPA (77% vs. 57%) positive, with a higher baseline ESR (54 mm/hr vs. 37 mm/hr). They also had a higher baseline HAQ (1.5 vs. 1.4, p=0.04). Over 8 years, despite similar suppression of DAS, patients with RRP had a statistically and clinically significantly higher HAQ than patients without RRP: difference 0.21 (95%C.I. 0.10-0.33). After adjustment for DAS over time, this difference was 0.14 (95%C.I. 0.05-0.24). The risk of joint damage progression ≥5 points SHS in year 1-8 was not different for patients with and without RRP. Patients with RRP did have an increased risk of damage progression ≥25 in year 1-8: OR of 4.6 (95% C.I. 1.6-12.7). Only 5% of the patients without RRP had more than 25 units progression in years 1-8.
Conclusions Rapid radiological progression is a clinically relevant outcome of prediction models of early RA patients, because it is an independent predictor of functional disability over 8 years in a disease activity steered treated cohort. Patients with rapid radiological progression in the first year of treatment continue to have more joint damage progression in subsequent years than patients without RRP.
Disclosure of Interest M. van den Broek Grant/Research support from: Dutch College of Health Insurances, Centocor inc and MSD (formerly Schering Plough), L. Dirven: None Declared, J. de Vries-Bouwstra: None Declared, A. Dehpoor: None Declared, Y. Goekoop-Ruiterman: None Declared, K. Han: None Declared, P. Kerstens: None Declared, T. Huizinga: None Declared, W. Lems: None Declared, C. Allaart: None Declared
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