Background Disease modifying anti-rheumatic drugs (DMARDs) are known to 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 Nine hundred forty-two patients with RA, treated not by biologic DMARDs but by synthetic DMARDs at entry, were registered between May 09 and March 12 in this study. We have selected 742 RA patients having DAS28-ESR at entry >3.2 or apparent radiographic bone erosion and followed at least 1 year. Regarding to the RA patients treated by synthetic DMARDs without biologic DMARDs for 1 year, three hundred ninety-two patients 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 RRP was found in 42 out of 392 patients (10.7%). Fourteen variables including gender, age, disease duration at baseline, DAS28-ESR/CRP at baseline, time-integrated DAS28-ESR/CRP during 1 year, ESR and CRP at baseline (mg/dl), presence of autoantibodies (RF or ACPA), the introduction of MTX or non-MTX DMARDs, the use of prednisolone, HAQ at baseline, mTSS at baseline were evaluated to explore the development of RRP at 1 year. Logistic regression analysis has found that female gender (p=0.023), high time-integrated DAS28-ESR/CRP (p=0.0094, 11.85 increase/p=0.0099, 10.91 increase) and high ESR/CRP at baseline (p=0.017, 22 mm/hr increase/p=0.049, 1.65 mg/dl increase) are independent variables to predict the development of RRP.
Conclusions Considering the development of RRP, the accumulated disease activity appeared to be most involved in this process. Therefore, tight disease control by treat-to-target strategy is needed in daily clinical practice.
Disclosure of Interest None declared