Objectives To compare the rate of radiological progression in patients with RA firstly diagnosed in the 1980s with those of the late 1990s until the era of biologic drugs and to evaluate key factors for differences in prognosis.
Methods 92 RA patients who were firstly seen in our clinic from 1997 to 2005 were identified. As a control group, 89 RA patients from 1986 to 1990 were matched for the criteria disease duration, age and number of x-ray controls from hands and forefeet. Radiological erosivity was measured by the Ratingen-Score (RS).
Results The initial RS was significantly lower in the 1997-2005 group in comparison to the 1986-1990 group (mean 3.8 ± 8.7 versus 7.7 ± 13.0 respectively, p<0.0001). Moreover, in the follow-ups the group 1997-2005 showed significantly less radiological progression than the group 1986-1990 (maximum mean Ratingen-Score 7.9 ± 13.3 versus 29.3 ± 27.9 respectively, p<0.0001). The most marked difference in treatment characteristics was a higher rate of patients who received MTX prior to the first consultation (35% versus 1%) and during follow-ups (73% versus 28%) in the 1997-2005 group compared to the 1986-1990 group. In 63 patients firstly seen from 2000 on, 21 (23%) patients received biologic drugs, mainly TNF-inhibitors during follow-ups. However, in comparison to those from 1997-1999 (n=25), therefore directly before approval of TNF-inhibitors, no difference in radiological erosivity was seen. Multivariant analysis showed that early start of MTX was a significant predictor of low radiographic progression (p<0.005), as were low ESR at baseline and belonging to the later group. In contrast, neither treatment with glucocorticoids or biologic drugs nor the overall rate of MTX-use were predictive.
Conclusions The results of this study indicate that radiological erosivity of RA patients is markedly diminished since mid of the 1990s. The high rate of early treatment with MTX seems to be a key factor for this improved prognosis.
Disclosure of Interest None Declared