Background Disease-modifying antirheumatic drugs (DMARDs) are known to inhibit radiographic progression in patients with rheumatoid arthritis (RA). Their effects are supposed to be different according to clinical condition, however, there have been few epidemiological reports of longitudinal investigation in RA patients captured in daily practice.
Objectives To determine prognostic factors of radiographic progression (RRP) in patients with RA in clinical practice for achieving treat to target strategy.
Methods We performed a Japanese multicenter prospective study on biological DMARDs (bDMARDs)-naïve 887 RA patients with moderate to high disease activity or with radiographic bone erosion, treated with conventional synthetic DMARDs (csDMARDs) at study entry. We observed longitudinally these patients for 1 year and assessed Disease Activity Score in 28 joint (DAS28-ESR) every 3 months. RRP was defined as yearly progression of modified total Sharp score (mTSS) >3.0U. Furthermore, we divided into two groups based on disease duration (<3 years or 3 ≥ years) and examined for subgroup analysis.
Results RRP was found in 9.2% of patients. Multiple step-wise regression analysis revealed that disease duration (OR=0.92, 95% CI 0.86 to 0.99), time-integrated DAS28-ESR during 1 year (OR=1.04, 95% CI 1.01 to 1.06), CRP at baseline (OR=1.24, 95% CI 1.07 to 1.43), and introduction of bDMARDs (OR=0.12, 95% CI 0.03 to 0.55) are independent variables to predict the development of RRP. Intriguingly, our subgroup analysis has revealed that time-integrated DAS28-ESR during 1 year is not a significant predictor for RRP in early RA and the protective effect of bDMARDs toward RRP is evident in early RA patients.
Conclusions RRP in RA patients treated with DMARDs is closely associated with persistent disease activity or early introduction of bDMARDs. Among early RA patient, subclinical RRP should be considered regardless of integrated disease activity.
Disclosure of Interest None declared