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.


Radiological Progression in Patients with Early RA and a Good Clinical Response to MTX Monotherapy: Predictors and Clinical Implications.

Rezaei3,  Hamed, Van Vollenhoven2,  Ronald, Forslind1,  Kristina, Albertsson3,  Kristina, Wallin3,  Helena, Geborek4,  Pierre, Ernestam3,  Sofia

Helsingborgs Hospital
Karolinska University Hospital, Stockholm, Sweden
Karolinska University Hospital
Lund University Hospital
Spenshult Hospital

Background:

In patients with early RA, several randomized trials have demonstrated the superiority of methotrexate (MTX) + anti-TNF over MTX alone. However, these trials also showed that some patients did have excellent responses to MTX monotherapy. In the SWEFOT trial, all patients were given an initial 3–4 months trial period with MTX alone; patients achieving a low disease activity state with this treatment were not randomized in the controlled portion of the trial. We previously demonstrated that this was the case for appr. 30% of the patients. In a separate report (Wallin et al, abstract submitted) we showed that these patients had an excellent clinical course during the first two years, but that some radiological progression did nonetheless occur. Here, we investigated specific details of and predictors for radiological progression in this cohort.

Objective:

To analyze in detail the radiological course in patients from the SWEFOT study who responded adequately to initial MTX monotherapy and who were not included in the randomized trial.

Methods:

A total of 487 patients with early RA (symptom duration <1 year) were started on MTX at a rapidly escalating dosage up to at least 20 mg/week. After 3–4 months, the 147 patients who had a DAS28<3.2 were not randomized but continued on MTX and followed in "regular care", including 3-monthly assessments. These patients were analyzed here. Van der Heijde modified Sharp scores (SvdH) were done by two experienced readers. Scores at different times were compared by Wilcoxon paired test. Complete x-ray data were available for 114 patients.

Results:

At baseline, the mean±SEM total SvdH score (median, IQR) was 3.8±0.7 (1, 0–5). After 1 year, it had increased to 6.0±0.8 (4, 0–8; p<0.0001 vs. baseline) and after 2 years to 7.9±0.9 (4, 0–8; p<0.0001 vs both BL and 1 year). Highly significant progression was seen for both erosion score and joint space narrowing score. The increase in total score after 2 years was 3.9±0.7 (2, 0–6). At baseline, 48.1% of patients had no x-ray damage (total score= 0); at 1 year 26.9%, and at 2 years 20.2%. An increase in total score >= 10, was seen in 15% of patients. RF positive patients had a trend towards greater progression than RF-negative ones: 4.78±0.91 (2, 0–7) vs. 1.90±0.78 (0, 0–5; p=0.067). For ACPA positive vs. negative, a smaller, non-significant difference was seen. Double-positive patients had the highest progression: 5.27±1.21 (2, 0–9). Single-positive RF had significantly higher progression than single-positive ACPA. Men had numerically more progression than women (5.00±1.05 (2, 0–9) vs 3.08±0.88 (1, 0–3; p=0.119).

Conclusions:

Patients who responded to an initial 3–4 months trial of MTX monotherapy with a DAS28<3.2 showed statistically significant (but on average numerically modest) radiological progression during the first 2 years of disease. Progression was associated with RF- and double-positivity. About half of all patients had no damage at baseline but the majority of these did develop damage over 2 years.

An initial good clinical response to MTX does not preclude a less favorable radiological course.

Supported in part by the Swedish Rheumatism Association and Schering-Plough.

To cite this abstract, please use the following information:
Rezaei, Hamed, Van Vollenhoven, Ronald, Forslind, Kristina, Albertsson, Kristina, Wallin, Helena, Geborek, Pierre, et al; Radiological Progression in Patients with Early RA and a Good Clinical Response to MTX Monotherapy: Predictors and Clinical Implications. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1392
DOI: 10.1002/art.29158

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