Background In 2013, a new EULAR definition of erosive disease for use in the 2010 ACR/EULAR rheumatoid arthritis (RA) classification criteria was published . We were interested in the characteristics of early RA patients with erosive disease according to this new definition, including their propensity to reach ACR/EULAR Boolean remission .
Objectives To characterize the clinical course of early RA patients with erosive disease participating in a clinical trial, at baseline and after a 4-year follow-up period.
Methods The presence of erosive disease was assessed at the baseline visit of early RA patients who were treated in the context of the COBRA-light trial [3,4]. After 52 weeks, treatment was continued without protocol. Erosive disease was defined as: “an erosion (defined as a cortical break) seen in at least three separate joints at any of the following sites: the proximal interphalangeal, the metacarpophalangeal, the wrist (counted as one joint) and the metatarsophalangeal joints on radiographs of both hands and feet” . Radiographs were scored by two independent trained assessors according to the Sharp/van der Heijde (SHS) method. ACR/EULAR Boolean remission was assessed at 3, 6, 9 months; and 1, 1.5, 2 and 4 years after trial initiation.
Results Only 8 (5%) of the 162 trial patients had erosive disease at baseline; these were somewhat older than patients without erosive disease at baseline (p=0.10). No differences in rheumatoid factor and ACPA status were found between erosive and non-erosive patients at baseline. After the 52 weeks trial period, 43% COBRA vs. 42% COBRA-light patients used prednisolone for ≥90 days, 34% vs. 44% patients switched to other DMARDs, and 39% vs. 28% used biologicals during the follow-up period. After a mean follow-up period of 4 years (data of 149 patients available), patients with erosive disease reported significantly higher disease activity (p=0.04) and pain (p=0.03) than patients without erosive disease, and a trend for more functional limitations (p=0.05) (Table 1). Likewise, the physician reported significantly higher disease activity (p=0.03); and both the SHS at 4 year (p<0.01) as well as SHS progression since baseline were higher for patients with erosive disease than patients without erosive disease (p=0.09). None of the erosive patients reached Boolean remission at any visit during the 4-year follow up-period, whereas 45% of the non-erosive patients did (p=0.01).
Conclusions In this exploratory study of early RA, erosive disease at baseline appeared to be rare. However, such disease is associated with a poor prognosis: more active disease, no remission, and worse 4-year outcomes despite a treat-to-target regime aimed at clinical remission.
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Disclosure of Interest N. Konijn: None declared, L. van Tuyl: None declared, M. Boers: None declared, D. den Uijl: None declared, M. ter Wee: None declared, P. Kerstens: None declared, A. Voskuyl: None declared, D. van Schaardenburg: None declared, M. Nurmohamed: None declared, W. Lems Grant/research support from: This study was supported by an unrestricted grant from Pfizer
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