Background The primary goal of current therapeutic strategies in RA is to control disease activity and at the same time to prevent radiographic progression. A disconnect between a missing radiographic progression and higher disease activity under treatment with biologic agents has been discussed. In general, analyses of radiographic progression in RA rather focus on radiographic non-progression or repair and high radiographic progression in spite of therapy has, to our knowledge not been analysed in detail in the last years, neither in RCTs nor in cohort studies.
Objectives To analyse the occurrence of high radiographic destruction and it's development in the era of biologic treatment.
Methods We included all RA patients from the Swiss registry SCQM with at least two subsequently scored radiographs. Radiographic destruction was scored with the Ratingen erosion score and calculated by dividing the change of Ratingen scores by time (>6 months) between two subsequent radiographs. To analyse high radiographic progression we looked for the height and time of the highest (peak) radiographic progression in every individual patient for the analysis. The individual peak radiographic progression was analysed in groups as change of Ratingen scores/year: 0-≤10, 10-≤20, 20-≤30, >30 (groups 1–4). The time point of the individual peak radiographic progression was analysed per group (follow up 1998 – 2015). The baseline disease characteristics were compared using standard descriptive statistics (Kruskal-Wallis or Chi-square tests).
Results 4'033 patients were included into the analysis. 3'049 patients had a peak radiographic progression between 0 and ≤10/year, 773 between 10 and ≤20, 150 between 20 and ≤30, and 61 of >30. All patient groups were within the same age range (mean: 56.5 – 60.5 years). Rheumatoid factor and ACPA were more frequent in patient groups with higher peak radiographic progression (RF: 73.6, 80.0, 88.9, 90.0; ACPA: 66.8, 73.4, 74.3, 82.1, groups 1–4, respectively). When the rate of radiographic progression before and after peak progression was analysed, 69.7%, 74.7%, 76.9%, and 93.3% of the patients had a radiographic progression of 25% or lower as compared to peak progression before and 76.1%, 81.8%, 91.1%, and 93.8% after this peak progression, respectively for patients in groups 1 to 4 (Figure A).
The disease activity, as assessed by DAS 28, was significantly higher in all patient groups before peak progression and lower thereafter (Figure B, p<0.001). Average HAQ-DI scores increased after peak radiographic progression in group 4 (Figure C, p=0.005) whereas it is stable or even decreases among the patients of the other patient groups.
Conclusions High peak radiographic progression is a rear phenomenon that gets less frequent in patients over the last years of observation. This may be an effect of modern therapy. Among the patients with high radiographic progression, (1) a greater delay between diagnosis and first symptoms was found and (2) the use of biologic agents was less frequent. These data suggest that the decreasing frequency of very high radiographic peak progression in the Swiss RA patients reflect a more effective therapeutic approach in the last years.
Disclosure of Interest None declared
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