Background Prognosis of RA patients nowadays are supposed to become better by treat-to-target (T2T) strategy. Osteitis determined by magnetic resonance imaging (MRI) is known as a predictor toward radiographic progression.
Objectives We have tried to examine precisely whether the change of therapeutic strategy affect the radiographic as well as clinical outcome of early-stage RA patients of Japanese population.
Methods All of the patients were recruited from Nagasaki University Early Arthritis Cohort in which the subjects received MRI of both wrist and finger joints. We have divided the periods of the Cohort into two parts. The first half includes the RA patients DMARDs treatment was initiated from 2003 to 2007 whereas the second half includes those DMARDs treatment was initiated from 2008 to 2011. All of patients gave their informed consent to be subjected to the protocol that was approved by the Institutional Review Board of Nagasaki University. Good outcome of the treatment assessed by MRI was set as the significant improvement of OMERACT-RAMRIS osteitis score (defined as the reduction of osteitis score less than 33% from the baseline) in the subjects osteitis detected at baseline or no appearance of osteitis. Good outcome of plain radiography and composite measure were no radiographic progression assessed by Genant-modified Sharp scoreand SDAI remission at 1 year, respectively. The change of good outcome was investigated by univariate and multivariate analyses.
Results Eighty-four RA patients could be examined. The first half included 43 whereas the second half 41 patients, respectively. The mean disease duration at entry was 4.6 months, and there were not significant difference in disease duration, gender, age as well as baseline variables including SDAI, RF titer, ACPA titer, CRP value, MMP-3 value, Genant-modified Sharp score and OMERACT-RAMRIS osteitis score between the first and second half. Stringent therapies such as the initiation by MTX and introduction of biologic DMARDs within a year were highly administrated in the second half as compared with first half. Significantly more patients in the second half achieved in good outcome of MRI, plain X ray and SDAI. In addition, logistic regression analysis has revealed that the above three good outcomes associate with each other.
Conclusions Present data suggest that stringent therapies in early-stage RA patients improve both radiographic and clinical outcome, indicating an importance of T2T in daily clinical practice.
References Kita J, Tamai M, Arima K, et al. Significant improvement in MRI-proven bone edema is associated with protection from structural damage in very early RA patients managed using the tight control approach. Mod Rheumatol. 2012 Jun 6. [Epub ahead of print]
Disclosure of Interest None Declared