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Level of radiographic damage and radiographic progression are determinants of physical function: a longitudinal analysis of the TEMPO trial
  1. D van der Heijde1,
  2. R Landewé2,
  3. R van Vollenhoven3,
  4. S Fatenejad4,
  5. L Klareskog3
  1. 1
    Leiden University Medical Centre, Leiden, The Netherlands
  2. 2
    University Hospital, Maastricht, The Netherlands
  3. 3
    Karolinska University Hospital, Stockholm, Sweden
  4. 4
    Wyeth Research, Collegeville, Pennsylvania, USA
  1. Professor D van der Heijde, Department of Rheumatology, Leiden University Medical Centre, PO Box 9600, 2300 CC Leiden, The Netherlands; d.vanderheijde{at}


Background: Many studies have examined the relationship between long-term radiographic damage and physical function. However, it is not known if short-term radiographic progression is also associated with physical function.

Aim: To investigate the longitudinal relationship between physical function and both the level of radiographic damage and the radiographic progression rate in patients with early or advanced active rheumatoid arthritis.

Methods: The database for the 2-year Trial of Etanercept and Methotrexate with Radiographic Patient Outcomes (TEMPO) was used for this study. Physical function was measured by the Health Assessment Questionnaire (HAQ) score at baseline, 6 months and 1 and 2 years. Radiographs of the hands and feet, taken at the same time points, were scored by the van der Heijde-modified Total Sharp Score (TSS). The HAQ score was modelled using generalised mixed linear modelling by TSS or progression in TSS (interval 0–1 year and 1–2 years) adjusted for age, sex, treatment and disease activity.

Results: After adjustment for age, sex and disease activity, both TSS and the change in TSS (progression rate) were significant determinants of the HAQ score. When radiographic progression was divided into four categories (negative, zero, minor and greater progression), results showed that HAQ scores tended to be higher with a higher rate of progression. Patients with negative progression scores had lower HAQ scores than patients with positive progression scores.

Conclusions: Patients with greater radiographic damage, and those with recent radiographic progression, have a higher degree of disability.

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  • Funding: Professional writing support was funded by Wyeth Pharmaceuticals

  • Competing interests: DvdH, RL and LK have received consulting fees from Wyeth, manufacturer of etanercept. RvV has declared no competing interests. SF is an employee and stockholder of Wyeth.

  • Ethics approval: Ethics committee approval obtained.