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 Space Narrowing Has a Stronger Impact on Physical Function Than Joint Erosion: Results from 8-Year Longitudinal Analyses.

Van Der Heijde2,  Desiree M., Landewe3,  Robert, Guerette1,  Benoit, Roy1,  Sanjoy, Patra1,  Kaushik, Keystone4,  Ed C.

Abbott Laboratories
Leiden University Medical Center, Meerssen, The Netherlands
Univ Hosp Maastricht, Maastricht, The Netherlands
University of Toronto, Toronto, ON, Canada

Background:

Structural damage, assessed by the modified Total Sharp Score (mTSS), has been shown to be related to physical function. Thus far, it remains unclear to what extent the individual components of the mTSS contribute to long-term physical function.

Objective:

To characterize the longitudinal relationship between physical function and Joint Space Narrowing (JSN) or Joint Erosion (JE) in patients with advanced RA.

Methods:

DE019 was a 52-week, randomized, placebo-controlled trial for the treatment of moderate to severe advanced RA, in which patients with an inadequate response to methotrexate (MTX) were randomized to MTX, adalimumab (ADA) 20 mg every other week (eow) + MTX, or ADA 40 mg eow + MTX. Patients completing the double-blind study were eligible to receive open-label ADA 40 mg eow + MTX for an additional 7 years. This post hoc analysis evaluated the 8-year completers cohort with radiographs at baseline and years 5, 6, and 8. 28-joint Disease Activity Score (DAS28) was used to assess clinical levels of disease activity. Physical function was assessed through the Health Assessment Questionnaire (HAQ). Radiographic damage was assessed using the modified Total Sharp Score (mTSS). Longitudinal generalized linear modeling was used to characterize the dependence of the HAQ on concurrent DAS28, total mTSS, JSN, and JE values, following adjustment for baseline age and gender and for concurrent CRP.

Results:

Over time, DAS28 was linearly associated with the HAQ (P <0.001). Similarly, the mTSS was significantly associated with the HAQ throughout treatment duration (P <0.001). A 1 unit increase in DAS28 and a 20 unit increase in mTSS were associated with 0.22 and 0.044 increases in the HAQ, respectively. A breakdown of mTSS into the individual components revealed that JSN more strongly impacted the HAQ over time than JE, although both were significant determinants (P <0.001 for both). A 20 unit increase in JSN and JE were associated with 0.1 and 0.06 increases in the HAQ, respectively. Interestingly, negative changes in mTSS trended towards lower HAQ values over time.

Conclusions:

For patients with advanced disease, long-term physical functioning is associated with both the level of disease activity (DAS28) and the extent of radiographic damage (mTSS). Of the contributors to the mTSS, JSN had a greater impact on the HAQ over time than JE, suggesting that therapies with high potency for inhibiting both the progression of JSN and JE should be considered.

To cite this abstract, please use the following information:
Van Der Heijde, Desiree M., Landewe, Robert, Guerette, Benoit, Roy, Sanjoy, Patra, Kaushik, Keystone, Ed C.; Joint Space Narrowing Has a Stronger Impact on Physical Function Than Joint Erosion: Results from 8-Year Longitudinal Analyses. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1113
DOI: 10.1002/art.28880

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