Background It is well known that disease modifying anti-rheumatic drugs (DMARDs) inhibit radiographic progression in patients with rheumatoid arthritis (RA), however, there has been few epidemiological report of longitudinal radiographic progression in RA patients captured in daily practice.
Objectives In 26 related-centers of the Nagasaki University and Tohoku University in Japan we are conducting a large-scale prospective study to investigate extent of radiographic progression. We have tried to assess the extent of rapid radiographic progression (RRP) in DMARDs-treated RA patients.
Methods We have selected the RA patients treated not by biologic DMARDs but by synthetic DMARDs for 1 year. Two hundred sixty-one out of the 996 patients registered between May 09 and March 12 had evaluable data at present. Patients gave their informed consent to be subjected to the protocol that was approved by the Institutional Review Board of Nagasaki University, Tohoku University and related centers. DAS28-ESR was assessed every 3 months. Radiographs of the hands and feet were taken every 6 months. The images were scored by trained readers through modified total Sharp score (mTSS). RRP was defined as yearly progression of mTSS >3.0. We have examined what variables are associated with the development of RRP at 1 year.
Results Eleven variables including gender, age, disease duration at baseline, DAS28-ESR at baseline, time-integrated DAS28-ESR during 1 year, CRP at baseline (mg/dl), presence of autoantibodies (RF or ACPA), the use of MTX or non-MTX DMARDs, the use of prednisolone, HAQ at baseline, mTSS at baseline were evaluated through univariate and logistic regression analysis to explore the development of RRP at 1 year. RRP was found in 31 out of 261 patients (11.9%). Logistic regression analysis has found that short disease duration (p = 0.013, 2 year decrease), high time-integrated DAS28-ESR (p = 0.027, 10 increase) and high mTSS at baseline (p = 0.010, 5 increase) are independent variables to predict the development of RRP. There was the trend of non-MTX DMARDs use (p = 0.071) toward RRP at 1 year.
Conclusions In RRP group, mTSS at baseline is high and the progression of joint destruction may occur at the early-stage of RAin case of treatment without MTX. Since not high DAS28-ESR at baseline but high time-integrated DAS28-ESR is also an independent predictor toward RRP, tight disease control by treat-to-target strategy is needed in daily clinical practice.
References Smolen JS, et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis 2010; 69: 631-7.
Disclosure of Interest None Declared