Rheumatoid arthritis joint progression in sustained remission is determined by disease activity levels preceding the period of radiographic assessment

Abstract

Objective. Joint damage is related to disease activity in rheumatoid arthritis (RA), but the degree of its progression and the temporal associations between disease activity and joint damage are unclear. The aim of this study was to evaluate whether there is a latency in the effect of disease activity on radiographic progression in patients with RA.Methods. Data were obtained from the PREMIER trial, a 2-year randomized, controlled clinical trial of adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in early RA. Radiographic progression of joint damage was calculated using the modified total Sharp score in a subset of patients whose disease was in remission (Simplified Disease Activity Index <3.3) in the second year of the trial. The progression of damage in the second year was compared between groups of patients whose disease was already in remission for an additional period of 3, 6, or 9 months during the first year. Analysis of variance was used to test for a linear trend.Results. Among 794 patients with early RA, 119 (15%) achieved sustained remission during the second year, with no difference in radiographic progression across the 3 treatment groups. Radiographic progression in the second year was significantly different between patients with 3, 6, or 9 additional months of remission during year 1 (mean change in the modified Sharp score 1.19 in those with 3 additional months of remission versus 0.20 in those with 6 additional months of remission and ؊0.32 in those with 9 additional months of remission; P < 0.05). The results were supported by similar findings in a series of sensitivity analyses.Conclusion. These data indicate that the level of disease activity as well as the duration of remission affect subsequent progression of radiographic damage in RA. This latency between disease activity and its effects on radiographic progression should be considered when evaluating radiographic outcomes in trials of RA.

Rapid Improvement in the Signs and Symptoms of Rheumatoid Arthritis Following Certolizumab Pegol Treatment Predicts Better Longterm Outcomes: Post-hoc Analysis of a Randomized Controlled Trial

“…Despite these limitations, the findings of this work are consistent with those of a growing body of other studies and recent recommendations for RA management 1,2,3,15,16,26,29,30,31,32 . The present data suggest that adjustment of therapy in the population evaluated in this study should be considered at Week 12 for patients with inadequate initial clinical response (defined as DAS28 change < 1.2).…”

Structural damages disturb functional improvement in patients with rheumatoid arthritis treated with etanercept

“…Therefore the first 4 years may be a ''window of opportunity'' to prevent disease progression to functional disability. Impaired physical function in patients with RA is governed by various factors, but Smolen et al [18,19] reported 186-194 191 that HAQ is composed of disease-activity-related HAQ and damage-related HAQ; changes in activity HAQ were mainly due to changes in disease activity, although there was little damage during a short-term therapeutic intervention, whereas HAQ would worsen with increasing damage. Actually, HAQ-DI similarly decreased in a group of patients whose baseline mTSS was [73.0 and in another group with mTSS \73.0, indicating that HAQ improvement did not depend on baseline mTSS and that etanercept improved activity-related HAQ.…”

Concepts in monitoring the treatment in rheumatoid arthritis – the role of musculoskeletal ultrasound. Part I: synovitis.

“…Remision at one point must be differentiated from sustained remission (>18 months), the last one being correlated to joint scores, radiologic progression, and residual disfunction reduction [99,100]. This information is important when readjustment of treatment strategy (tapering/ arrest) is discussed [77,101].…”