Background Joint destruction is a major cause of disability in patients with rheumatoid arthritis (RA). Early predictors of rapid joint destruction would be helpful in clinical decision-making, with the potential to yield better patient outcomes. There are conflicting data on the impact of smoking on radiographic progression, and limited information on the importance of disease activity over time in this context.
Objectives To study the relation between patient characteristics at RA diagnosis (baseline) and after 1 year and subsequent rapid radiographic progression (RRP) of joint damage over 5 years.
Methods An inception cohort of patients with early RA (symptom duration <12 months), recruited in 1995–2005 from a defined area, was investigated. Patients were followed according to a structured program, with follow-up visits at 12 and 60 months after inclusion. The same rheumatologist performed the clinical examinations. Those included in the study were managed according to usual care, with no pre-specified protocol for anti-rheumatic treatment. Radiographs of hands and feet were scored in chronological order by a trained reader according to the modified Sharp-van der Heijde score (SHS). RRP was defined as an increase of ≥5 points in SHS per year. Logistic regression models were used to assess potential predictors of RRP.
Results Two hundred and thirty three patients with early RA (70% women, mean age 62 years, 62% RF- and 58% anti-CCP positive) were included. Radiographs were available from 232 patients at baseline, 211 at 1 year and 164 at 5 years. Thirty-six patients were classified as RRP from baseline to 5 years, and the same number from year 1 to 5 years. As expected, RF (odds ratio (OR) 5.70; 95% confidence interval (CI) 1.90–17.10) and anti-CCP (OR 6.04; 95% CI 1.98–18.47) were predictive of RRP over 5 years. A history of ever smoking was associated with a significantly increased risk of RRP up to 5 years (OR 2.69; 95% CI 1.01–7.18, adjusted for RF and baseline presence of erosions). High CRP and ESR at inclusion were predictive of RRP, whereas there were no significant associations for baseline DAS28, swollen joint count, tender joint count or patient's global assessment (Table 1). At the 1-year follow-up, in addition DAS28 and swollen joint count were also significantly associated with RRP up to 5 years (Table 1). Elevated CRP (>9 mg/l) at 1 year was a robust predictor of subsequent RRP (adjusted OR 6.98; 95% CI 2.85–17.14).
Conclusions Early RA patients with a history of smoking were more likely to have rapidly progressive joint damage. High disease activity measures at 1 year were strongly associated with rapid radiographic progression. These results underline the importance of early successful anti-rheumatic treatment and suppression of disease activity, to lower the risk of rapid joint destruction in early RA.
Disclosure of Interest None declared