Background Rapid Radiographic Progression (RRP) in Rheumatoid Arthritis (RA) patients predicts long-term disability (1), high related economic costs (2) and loss of working time (3). Detection of RRP predictors as a necessary tool for aggressive therapeutic interventions has been proved, but in Latin-American cohorts, no available data had been reported.
Objectives To determine independent risk factors associated with RRP in a cohort of RA patients
Methods A prospective analysis of RA Almenara cohort (January 2015-April 2016), 500 patients followed up with annual evaluations (background clinical/epidemiology, clinimetric, laboratory, health questionnaires and X-rays) who meet ACR 87/ACR-EULAR 2010 criteria's, older than 16 years at diagnosis,sign informed consent. Patients with overlap (except Sjögren), with active infections and/or pregnancy are excluded. Patients with at least two radiographs (baseline/final) were included. The X-rays were taken in a standardized protocol (each hand and foot). Joint damage was measured by Sharp-VDH (erosions, decreased joint space, and total scores). Radiographic Progression (RP) as a annual difference in Sharp-VDH score and RRP (>5 units in RP) were determined. A blinded rheumatologist for the RA condition read all films. Associated factors were analyzed (gender, socioeconomic level, smoking, age at diagnosis, time disease, use of biological and non-biological DMARDs, DAS 28, current steroids, HAQ/functional capacity, RF and basal SharpVDH score). Diagnosis delay and CRP were included to analyze risk factors in the RRP group. Statistical analyzesTweedie regression models with logarithm link. SPSS v. 21.0 was used
Results 153 patients, 90.8% women, middle low (37.9%) and middle (35.3%) the most prevalent socioeconomic status. Age at diagnosis was 46.06 (12.73) years, time disease 14.25 (10.26) years. DAS28 average: 4.51 (1.33). Basal Sharp VDH:104.53 (90.09), CRP: 9.77 (10.35) UI/L, RF: 352.49 (538.08) UI/L, ACPA: 563.64 (782.2)UI/dL. PR annual rate was 7.64 (2.4 years of follow up),94.8% increased damage and 74 patients (48.36%) had PRR. Most subjects (94.1%) were using DMARDs but only 15 (9.8%) biologicals. The mean dose of prednisone was 4.88 (3.33) mg/d. In the univariate analysis, only DMARDs was associated with RP (B=50.8; CI=40.13–51.48, p<0.001), remaining this association in the multivariate analysis (B=50.56;CI=49.80–51.33,p<0.001). In the multivariate analysis of RRP group, no variables was associated with risk and subjects with steroids use had less radiographic impairment (B=0.859; CI 0.759–0, 893,p=0.017).
Conclusions In this prospective study of an established RA cohort, a large proportion of patients had RRP and there was few percentage of biologic use. In the RRP subset only steroids use was a protective factor.
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Disclosure of Interest None declared