Background Bone erosion is a central pathophysiological process in rheumatoid arthritis (RA) leading to joint destruction and functional limitations. Measurement of the degree of joint damage represents an important tool to assess disease progression and effectiveness of current treatments. Repair of existing bone erosions have been described but the extent and significance of this is so far unclear.
Objectives The aim of this study was to examine the incidence of repair of erosions in patients with early RA during eight years and to look for possible factors linked to repair.
Methods 473 patients from the BARFOT (Better Anti-Rheumatic FarmacOTherapy) inception RA cohort were included into the study71% were women, mean age 55 years, 63% were rheumatoid factor (RF)-positive and 59% current or previous smokers. All patients had radiographs of hands and feet at inclusion into the study (baseline), 1, 2, 5, and 8 years.
Erosion scores were measured by the Sharp-van der Heijde scoring (SHS) method. Sustained remission was defined as a DAS28 <2.6 at all follow-up visits.
Repair was defined as complete healing or reduction in size of the erosion.
Results After one year, presence of repair was found in 82 patients (17%), after two years in 140 (30%), after 5 years in 179 (38%) and after 8 years in 203 (51%). At 1, 2, 5 and 8 years these patients had 153, 260, 424 and 717 erosions with repair, respectively.
The number of repairs at the follow-up visits correlated weakly or moderately with the erosion scores, r=0.2–0.4, p=0.001.
The sum of the number of erosions showing repair recorded at each follow-up visit (total repairs) was 1.554 and the corresponding sum of erosion scores (total erosion scores) was 10.867. The total repairs correlated strongly with total erosion scores, r=0.7, p=0.001. The mean total repairs was associated with RF positivity, p=0.001 but not with gender, p=0.23.
The mean number of repairs was significantly higher in RF-positive patients at 2 and 8 years, 0.62 vs 0.37, (p=0.010) and 2.16 vs 1.18, (p=0.001). Presence of repair was significantly associated with RF-positivity at 2, 5, and 8 years and with gender at 8 years, 61% in men vs 47% in women (p=0.011).
The mean total repairs was significantly lower in patients in sustained remission compared with the rest of the patients, 2.3 vs 3.7, p=0.008.
There was no significant correlation between number of repairs and baseline DAS28 at any follow-up visit. Treatment with a combination of conventional DMARDs was associated with presence of repair after 1 (p=0.048) and 5 (p=0.001) years. After 8 years biologic DMARD therapy was more common in patients with some repair (p=0.011). Prednisolone treatment did not significantly influence repair.
Conclusions In this cohort of patients with early RA, repair was more common than previously described. Repair of erosions occurred with increasing frequency during the 8 year study and was associated with rheumatoid factor positivity. Patients in sustained remission showed fewer repairs.
Disclosure of Interest None declared
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