Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Rapid Radiological Progression in the First Year of Rheumatoid Arthritis Predicts Both Disability and Radiological Joint Damage Progression Over 8 Years of Targeted Treatment.
van den Broek1, M., Dirven1, L., Dehpoor1, A.J., de Vries-Bouwstra1, J.K., Goekoop-Ruiterman2, Y.P., Peeters3, A.J., Kerstens4, P.J.S.M.
Leiden University Medical Center, Leiden, Netherlands
HAGA hospital, The Hague, Netherlands
Reinier de Graaf Gasthuis, Delft, Netherlands
Jan van Breemen Research Institute|Reade, Amsterdam, Netherlands
VU University medical center, Amsterdam, Netherlands
To assess whether rapid radiological progression in the first year of treatment of RA is associated with functional disability and progressive joint damage over 8 years of tight control targeted treatment.
All patients with radiological data at baseline and after 1 year from the BeSt study were used in this analysis. All patients were dynamically treated with medication adjustments aimed at achieving a disease activity score (DAS) =<2.4, measured three-monthly. Rapid radiological progression (RRP) was defined as an increase of >= 5 points Sharp v/d Heijde Score (SHS) as scored after the first year of treatment. Functional ability over 8 years, measured 3-monthly with the Health Assessment Questionnaire (HAQ), was compared in patients with and without RRP using linear mixed models, adjusted for treatment group, baseline ESR, SHS and rheumatoid factor (RF), anti-citrullinated protein antibody-status (ACPA) or a combination of RF and ACPA. Subsequently, disease activity score (DAS) over time was added to this model.
RRP was observed in 102/463 (22%) patients. Patients with RRP were more often treated with initial monotherapy (74% vs. 41%) than patients without RRP and more often RF (82% vs. 60%) and ACPA (77% vs. 55%) positive, with a higher baseline ESR (53 mm/hr vs. 37 mm/hr). They also had a higher baseline HAQ (1.5 vs. 1.4, p=0.04).
Over 8 years, despite relatively equal suppression of DAS in both groups, patients with RRP had a statistically and clinically significantly higher HAQ (difference 0.22, 95% C.I. 0.090.34) (figure 1). After adjustment for DAS over time, this difference was 0.15 (0.050.26). Patients with RRP in the first year had more joint damage progression in year 1 to year 8 (figure 2).
Figure 1. Mean HAQ over time, adjusted for treatment strategy, baseline ESR and SHS and RF and/or ACPA (using linear mixed models) for patients with and without RRP in year 1.
Figure 2. Mean yearly joint damage progression for patients with and without RRP in year 1.
In a tight control cohort of recent onset RA patients with treatment targeted at DAS =<2.4, rapid radiological progression in year 1 is an independent predictor of functional disability over 8 years. Approximately one third of the difference in functional ability between patients with and without RRP is explained by differences in disease activity. Patients with rapid radiological progression in the first year of treatment continue to have more joint damage progression in subsequent years than patients without RRP.
To cite this abstract, please use the following information:
van den Broek, M., Dirven, L., Dehpoor, A.J., de Vries-Bouwstra, J.K., Goekoop-Ruiterman, Y.P., Peeters, A.J., et al; Rapid Radiological Progression in the First Year of Rheumatoid Arthritis Predicts Both Disability and Radiological Joint Damage Progression Over 8 Years of Targeted Treatment. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :418