Intensive treatment for the progression of joint damage in rheumatoid arthritis patients with low disease activity or remission

Abstract

Objectives To investigate the effects of intensive treatment on joint damage in patients with rheumatoid arthritis (RA) showing progression of joint damage, and low disease activity or remission. Methods 89 patients who had change in the van der Heijde modified total Sharp score (TSS) of > 0.5 points at baseline when compared with the score 1 year ago were enrolled and categorized into two groups to receive intensive (intensive group) or current (current group) treatment. The intensive group included patients with (1) addition of biological disease-modifying antirheumatic drugs (bDMARDs) or targeted synthetic DMARDs, (2) switch of bDMARDs, (3) addition of conventional synthetic DMARDs, and (4) increases in the MTX dose. The intensive and current groups were compared change (Δ) from baseline to 1 year of erosion score, joint space narrowing score, and TSS. Results The ΔTSS values at 1 year in the intensive and current groups were 0.67 ± 1.09 and 1.79 ± 1.70, respectively (p < 0.001). The Δerosion scores at 1 year in the intensive and current groups were 0.10 ± 0.44 and 0.38 ± 1.20, respectively (p = 0.113). The Δjoint space narrowing scores at 1 year in the intensive and current groups were 0.57 ± 0.84 and 1.41 ± 1.78, respectively (p < 0.001). In the intensive and current groups, the ΔTSS ≤ 0.5 at 1 year were 66.7% and 32.4%, respectively (p = 0.010). Conclusions The intensive treatment was more effective at suppressing joint damage than the current treatment. The progression of joint damage is an important target to consider for intensive treatment.