Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Joint Damage Progresses in DAS28 Remission and Is Driven by Residual Joint Swelling.
Smolen, Josef S., Aletaha, Daniel
Remission is usually defined as a state of no (or minimal) residual clinical disease activity and ideally should go along with maximal reduction of physical disability and halt of progression of joint damage. The Disease Activity Score employing 28 joint counts (DAS28) is frequently used to assess remission (DAS28<2.6), however, there is often residual disease activity in this state1. It is currently not known to which extent joint damage is retarded in DAS28 remission.
We evaluated data from methotrexate (MTX) monotherapy arms of recent trials (ASPIRE, ERA, Leflunomide, PREMIER, TEMPO). We pooled patients with complete clinical data at baseline, 6, 9 and 12 months and X-ray data at baseline and 12 months (n=865). We identified patients who attained persistent DAS28 remission, defined as an average DAS28 from 6 to 12 months (DAS28612) <2.6. For each of these patients, we calculated mean SJC for the 612 month period and then divided the patients into those without (SJC612<2) and with (SJC612>=2) joint swelling. We assessed the radiographic progression of TSS between these two groups. We compared the proportion of patients progressing radiographically (increase of TSS score of >0.52) by Chi2 statistics.
115 patients (13.3%) achieved DAS28<2.6; 22 of them (19%) had a mean SJC612>=2. DAS28 remitters without residual joint swelling showed a 1 year radiographic progression of 0.56±4.17, while those with residual swelling progressed by 2.16±4.22 TTS points. The proportion of patients with a TSS progression >0.5 was significantly higher in patients with residual joint swelling (50.0%) compared to those without (23.9%; p=0.015). Residual SJC were decisive for damage progression in DAS28 remission, since neither DAS28 levels nor tender joint count or ESR influenced it in DAS28 remission (not shown). We then compared DAS28 remission data with those in remission by the simplified and clinical disease activity indices: in SDAI (<=3.3) and CDAI (<=2.8) remission no patient had SJC>2 and damage progressed only by 0.5±5.9 and 0.6±5.3, almost identical as in DAS28 remitters who had no residual SJC. Interestingly, there were also significant differences in physical function: while HAQ was low in DAS28 remission (0.21±0.35), it was even lower in SDAI (0.09±0.18; p=0.0023) and CDAI remission (0.12±0.26; p=0.057).
A large proportion of patients in DAS28 remission not only have significant residual swollen joint count but also significant progression of damage, indicating that more stringent criteria for remission are needed. SDAI and CDAI criteria were more stringent regarding progression of joint damage and residual disability.
Acknowledgement. We thank Abbott, Amgen, Centocor, Sanofi-Aventis and Pfizer-Wyeth for providing us with data of their clinical trials and Farideh Alasti for statistical support.
(1) Makinen H et al Ann Rheum Dis 2005; 64:14101413; (2) van der Heijde D et al. Arthritis Rheum 2002; 47:215218.
To cite this abstract, please use the following information:
Smolen, Josef S., Aletaha, Daniel; Joint Damage Progresses in DAS28 Remission and Is Driven by Residual Joint Swelling. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :73