Background Rapid radiographic progression (RRP) leading to severe destruction of small joints occurs in 10%–20% of patients with rheumatoid arthritis (RA), even when biological agents are used. The cause of the RRP is still unclear, and treatment is very difficult. Meanwhile, there have been no reports about the destruction of medium and large (M-L) sized joints in patients with RRP.
Objectives To analyze 46 patients with RA who have been treated with adalimumab (ADA) for 1 year and have been taken radiographs of both small and M-L sized joints by investigating the destruction of M-L sized joints in the RRP group.
Methods The modified total sharp score (mTSS) were assessed to find RRP (ΔmTSS/year>3). Twelve M-L sized joints (bilateral elbow, shoulder, hip, knee, ankle, and subtalar joints) were radiographically assessed by the Larsen method (Grade 0–5). Seven RRP patients (84 joints) were compared with 39 non- RRP patients (468 joints) to estimate M-L sized joints destruction. The chi-squared test and the Wilcoxon test were used for the statistical analysis.
Results In 46 patients, the baseline characteristics (mean) were age: 60.9 years, disease duration: 110.7 months, pre-trial treatment with a biological agent: 2%(1 pt), concomitant MTX use :91%, DAS28-ESR: 6.04, HAQ-DI: 1.73, mTSS;65.4, mTSS/y before ADA treatment: 11.4, M-L sized joint Larsen grade/joint :1.09, M-L joint Larsen grade/y/joint: 0.34, RF:119.4IU /ml(89% positive), MMP-3: 384ng/ml and CRP: 2.92 mg/dl. DAS28-ESR, HAQ-DI, ΔmTSS/year, 1 year after ADA treatment were 3.57, 1.02 and -0.69. Seven patients were in RRP group (ΔmTSS/y: 7.24) and 39 were in non-RRP group ( ΔmTSS/y: -2.15). Between two groups, no significance was observed in baseline average Larsen grade /joint and average Larsen grade/joint/year, however slight trend has been observed in ΔDAS28-ESR/y (RRP;1.81, non-RRP;2.59, p=0.053). Out of the 468 M-L sized joints examined in non RRP group, there was progression in 10 joints (2 elbow, 2 shoulder, 4 knee, 2 hip joints ), improvement in 9 joints (3 elbow, 2shoulder, knee, 3 subtalar joints). Percentages of progression and improvement of joint destruction in patients with Larsen grade 0-2, were 1.2 %(5/414), 0.98%(4/414), and percentages in patients with Larsen grade3-4 was 12.8% (5/39),17.9%(7/39), respectively. Out of the 84 M-L sized joints examined in RRP group, there was progression in 3 joints( elbow, shoulder, knee joint ), and no improved joints were observed. Percentages of progressive joints in Larsen grade0-2, were 2.53%(2/79),0%(0/79), and percentages in patients with Larsen grade3-4 was 25%(1/4),0%(0/4), respectively. Progression of Larsen grades/joint was not significantly observed in RRP group (Larsen grade0-2, grade3-4, total) compared with in non-RRP group. Lack of joint repair was observed only in RRP group, however no significance was observed in improvement of Larsen grades/joint between both groups.
Conclusions Progression of M-L sized joint destruction in RRP group was not significantly observed compared with that in non-RRP group in Adalimumab treated RA patients.
Disclosure of Interest None Declared