Background The effectiveness of biologic disease modifying anti-rheumatic drugs (DMARDs) on clinical outcome in rheumatoid arthritis (RA) has been studied in several biologic DMARD registries. However, real life long term clinical follow up data and in particular radiographic outcome data are limited (ref.1,2).
Objectives To study short- and long term clinical and radiographic outcome in patients with early RA treated according to standard clinical care in the first decade of the biologic treatment era.
Methods Early RA patients from an ordinary rheumatology out-patient clinic, all fulfilling the ACR 1987 criteria, were between 1999 and 2001 consecutively enrolled. According to protocol data on demographic, disease activity, health status and treatment was collected at baseline and after 6 months, 2, 5 and 10 years follow up. The radiographs of hands and feet were performed at baseline and after 2, 5 and 10 years and scored according to the van der Heijde modified Sharp score (SHS). Data were presented as percentage for categorical variables and for continuous variables as mean with standard deviation (SD) or median with interquartile range [IQR].
Results Baseline mean age for the 94 (36 men and 58 women) patients was 50.4 years, symptom duration 12.3 months and 68% were rheumatoid factor positive and 70% had erosions on radiographs. The proportion of RA patients in DAS28 remission, low, moderate and high disease activity status was at baseline 4.3%, 1.1%, 35.1% and 59.6%, at 2 years visit 29.0%, 10.8%, 50.5% and 9.7%, at 5 years visit 33.3%, 24.7%, 42,0% and 0% and at 10 years visit 52.1%, 20.5%, 27.4% and 0.0%, respectively. In the table below mean (SD) baseline and data at follow up visits are shown for measures of disease activity, health status and mean and median values for SHS score. The mean (SD) annual change in SHS score for the period 0-2, 2-5 and 5-10 years period was 3.4 (6.3), 1.7 (2.9) and 1.2 (2.7) and for median [IQR] change 0.8 [3.5], 0.3 [2.0] and 0.6 [1.6], respectively. For the 0-2 year period 62.8% had used prednisolone, 91.5% synthetic DMARDs and 18.1% biologic DMARDs and for the 2-10 year period the figures were 50.6%, 89.3% and 62.7% respectively.
Conclusions The vast majority of our RA patients achieved a status of clinical remission or low disease activity and had minor deterioration in radiographic joint damage during short and long term follow up.
Ornbjerg LM, et al. Impact of tumour necrosis factor inhibitor treatment on radiographic progression in rheumatoid arthritis patients in clinical practice: results from the nationwide Danish DANBIO registry. Ann Rheum Dis. 2013;72:57-63.
Descalzo MA, et al. Effectiveness of a clinical practice intervention in early rheumatoid arthritis. Arthritis Care Res. 2012;64:321-30.
Disclosure of Interest G. Haugeberg Grant/research support from: Unrestricted grant from Pfizer, P. Bøyesen: None declared, K. Helgetveit: None declared, A. Prøven: None declared