Background The joint destruction in rheumatoid arthritis (RA) are well known to progress for an onset early stage. Therefore, the treatment intervention that is appropriate from an onset early stage is important in RA. However, there were few reports about the progression of joint destruction for a long term with the early Asian RA patients.
Objectives For early Japanese RA, we performed early conventional DMARDs treatment and analyzed radiographic progression of hands and reviewed it in retrospective about the progression of joint destruction.
Methods We intended for twenty Japanese RA patients which we performed early treatment by conventional DMARDs for onset less than 1 year and were able to follow up more than 15 years. Treatment was initiated between 1989 and 1993 at the Department of Rheumatology, Toyohashi Municipal Hospital, and who met the diagnostic criteria stipulated by the American College of Rheumatology in 1987. All cases were female, RA onset time average age was 45.3±13.3 years old, the onset for average was 6.2±4.0 months from the period to a DMARD start, and first DMARDs was all gold (Gold sodium isothiomalate ; 14 cases, Auranofin ; 6 cases). Number of the tender joints ; 6.4±4.6, number of the swelling joints ; 3.3±3.4, CRP ; 3.1 ±3.6mg/dl, DAS-CRP3 ;4.12±0.97 at the time of the initiation, RF positive ; 17 cases (85%), number of DMARDs for 15 years ; 3.8±2.0 which they used were agents, were all non biolosics. We used modified Sharp method (van der Heidje method) with both hands using simple radiographs and evaluated the joint destruction at initiation, 5, 10 and 15 year.
Results Radiographs at the time of the initiation already showed a bone erosions in six cases, and, as for the TSS, 3.5±5.1 at the time of the initiation changed into each 44.5±34.9, 76.0±42.6 and 92.3±48.5 at 5, 10 and 15 years. Mean yeary progression of TSS was 7.8/y, 6.3/y and 3.3/y at 0-5 years, 5-10 years and 10-15 years. In the bone erosion-positive group (n=6) and negative group (n = 14) at initiation, the respective changes in TSS at 5, 10 and 15 year were as follows: 5 year: 37.3 ± 36.2 and 61.2 ± 27.5 (p = 0.063); 10 year : 69.9 ± 44.7 and 90.0± 36.8 (p = 0.283); and 15year : 85.4± 51.6 and 108.7± 39.7 (p = 0.322). In the RF-positive group (n=17) and nagative group (n = 3), the respective changes in TSS at 5, 10 and 15 year were as follows: 5 year: 47.3 ± 28.3 and 17.3 ± 12.4 (p = 0.525); 10 year : 82.5 ± 42.5 and 38.7± 17.0 (p = 0.081); and 15year : 100.6 ± 47.5 and 45.7± 21.9 (p = 0.05). The correlation between the number of use conventional DMARDs for 15 years and the TSS at 5, 10 and 15 year were each 0.702, 0.718 and 0.711 (p<0.001, p<0.001, p<0.001).
Conclusions The joint destruction progressed most in first 5 years, and tended to progress for the case to present a bone erosion at initiation in first 5 years. In the RF-positive patients the joint destruction progressed significantly for a long term. A control of RA was insufficient, and the case that there was much number of conventional DMARDs to use is at risk factor of the progression of joint destruction.
Disclosure of Interest None Declared
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