Background Treatment for rheumatoid arthritis (RA) has changed over the past decade. Early diagnosis and prompt agressive treatment based on treat to target strategy, as well as complementary ultrasound have been adopted and proven to improve patient clinical and radiological outcomes in clinical trials.
Objectives The aim of this study was to compare radiographic progression of early RA patients starting their first DMARD 10 years ago vs more recently in daily clinical practice.
Methods We reviewed the medical records of consecutive patients with symptom of 3 years duration who fulfilled the 1987 ACR classification criteria or the 2010 ACR/EULAR classification criteria in a single center retrospectively. In the first cohort (2000s), 70 patients (55.3±13.3y.o, Female 77%) who were diagnosed with RA during 2003–2005 were included. in the second cohort (2010s), 71 patients (54.5±17.3y.o,Female90%) who were diagnosed with RA during 2013–2015 were included. Radiographs of hands were assessed at baseline and one year after according to the van der Heijde modified Sharp score (range 0–280) without clinical information and chronological orders of radiographs in the individual patients.
Results Mean changes in radiographic joint damage for joint space narrowing score, erosion score, total radiographic score were higher in 2000s than 2010s (0.92±2.70 vs 0.28±1.86; p=0.010, 0.54±1.35 vs 0.35±0.99; p=0.390, 1.45±3.54 vs 0.68±2.55; p=0.015, respectively). Radiographic progression defined as total radiographic score >0 and >5 were 31.4% vs 22.5% and 8.6% vs 8.5% between 2000s and 2010s (p=0.230 and p=0.970, respectively). Methotrexate (MTX) was frequently used for initial treatment in 2010s than 2000s (86% vs55%, p≤0.001), and initial dose and maximum dose of MTX were higher in 2010s than 2000s (9.13±2.09 mg/week vs 4.67±1.54 mg/week; p≤0.001 and 12.04±3.73 mg/week vs 8.13±1.88 mg/week; p≤0.001, respectively). The mean duration from symptom onset to diagnosis was earlier in 2010s than 2000s (5.75±5.04 months vs 7.85.±6.85 months, p=0.001). CRP at baseline and 1 year after were lower in 2010s than in 2000s (2.74±1.90 mg/dL vs 3.35±3.94 mg/dl; p=0.001 and 0.60±1.19 mg/dL vs 1.20±1.99 mg/dl; p=0.03 respectively). There were no significant differences in sex, age, positive rate of RF and ACPA, the Sharp score at baseline, steroid use, and biological agents use between two cohorts.
Conclusions In recent 10 years, early diagnosis with complementary ultrasound and appropriate MTX use based on treat to target strategy led to prevent joint destruction of RA patients in daily clinical practice.
Disclosure of Interest None declared