The links between joint damage and disability in rheumatoid arthritis

108

Objective. To evaluate the impact of infliximab therapy on the employment status of patients with early rheumatoid arthritis (RA).Methods. Methotrexate (MTX)-naive patients with active early RA were randomly allocated to receive MTX plus placebo or MTX plus infliximab (3 mg/kg or 6 mg/kg) at weeks 0, 2, and 6 and then every 8 weeks through week 46. Data for patients younger than age 65 years were included in the analyses. A patient was categorized as employable if he or she was employed or felt well enough to work if a job were available.Results. The change in actual employment was not significantly different between patients receiving MTX plus infliximab and those receiving MTX plus placebo (0.5% versus 1.3%; P > 0.5). However, the proportion of patients whose status changed from employable at baseline to unemployable at week 54 was smaller in the group receiving MTX plus infliximab compared with that in the group receiving MTX alone (8% versus 14%; P ‫؍‬ 0.05). Patients who were treated with infliximab plus MTX had a significantly greater likelihood of improvement rather than deterioration in employability (odds ratio 2.4; P < 0.001); this likelihood was not significantly greater in patients receiving MTX alone. The proportion of employed patients who lost workdays during the trial was smaller in the MTX plus infliximab group than in the MTX-alone group (P ‫؍‬ 0.010). Conclusion. The actual employment rates among patients in the 2 treatment groups were not different. However, patients with early RA who were treated with MTX plus infliximab had a higher probability of maintaining their employability compared with those who were treated with MTX alone.

Section: Discussionmentioning

confidence: 99%

Infliximab treatment maintains employability in patients with early rheumatoid arthritis

Smolen

Han²,

Heijde

et al. 2006

108

“…In early RA, radiographic status is not related to functional outcome measures such as the Health Assessment Questionnaire (13) score, and in established disease (duration 5-8 years) changes visualized by radiography explain only ϳ25% of disability in patients with established RA (14). It appears likely that the more detailed information provided by MRI could capture disease manifestations responsible for a higher proportion of patient disability.…”

Section: Discussionmentioning

confidence: 99%

New radiographic bone erosions in the wrists of patients with rheumatoid arthritis are detectable with magnetic resonance imaging a median of two years earlier

Østergaard¹,

Hansen²,

Stoltenberg³

et al. 2003

169

Objective. In a 5-year followup study, we investigated the temporal relationship between development of wrist joint erosions as visualized by magnetic resonance imaging (MRI) versus conventional radiography (CR), in patients with rheumatoid arthritis. We also evaluated the risk of erosive progression on CR associated with the presence of MRI erosions.Methods. In 10 patients with rheumatoid arthritis, MRI and CR of the dominant wrist were performed annually for 5 years. In each image set, each wrist bone (metacarpal bases, carpal bones, radius, and ulna) was assessed for the absence or presence of bone erosions.Results. Nine bones showed radiographic erosions at baseline. Twenty-seven new radiographic erosions developed during the 5-year followup period. Of these 27 new erosions, 21 were detected 1-5 years earlier by MRI than by CR, 3 were simultaneously detected by both methods, 2 were detected 1-2 years later by MRI than by CR, and 1 erosion (radiographically detected at 5-year followup) was not visualized with MRI. MRI detection of new radiographic erosions preceded CR detection by a median of 2 years. In bones with MRI erosions at baseline, the relative risk of radiographic erosions at 5-year followup was 4.5 (95% confidence interval [95% CI] 2.6-7.6), compared with bones without baseline MRI erosions. If bones with baseline radiographic erosions were excluded from the analysis, the relative risk was 4.1 (95% CI 2.2-7.5).Conclusion. Most new radiographic bone erosions (78%) were visualized at least 1 year earlier by MRI than by CR. This illustrates that the information on joint destruction provided by CR is considerably delayed compared with that provided by MRI. A significantly increased risk of progression of radiographic erosion in bones with baseline MRI erosions was observed, demonstrating a prognostic value of MRI with respect to long-term radiographic outcome.

“…A DAS28 nonresponse was defined as an improvement of Ͻ0.6 points or a final DAS28 score of Ͼ5.1 points. Patients achieving clinical remission at 6 months were identified according to EULAR criteria (DAS28 Ͻ2.6 points) (38). In addition, the patient's global assessment of his or her overall health was recorded at each visit, using a visual analog scale of 0-100 mm, where 0 ϭ best and 100 ϭ worst.…”

Section: Methodsmentioning

confidence: 99%

Early changes in serum type ii collagen biomarkers predict radiographic progression at one year in inflammatory arthritis patients after biologic therapy

Mullan¹,

Matthews²,

Bresnihan³

et al. 2007

Objective. To investigate whether short-term changes in serum biomarkers of type II collagen degradation (C2C) and types I and II collagen degradation (C1,2C), as well as the biomarker for the synthesis of type II procollagen (CPII) can predict radiographic progression at 1 year following initiation of biologic therapy in patients with inflammatory arthritis.Methods. Serum levels of biomarkers were measured at baseline and at 1, 3, 6, 9, and 12 months after initiation of biologic therapy. A composite score reflecting changes from baseline in all 3 biomarkers (⌬COL) was calculated. Associations with clinical responses according to the 28-joint count Disease Activity Score and with radiographic progression according to the modified Sharp/van der Heijde score (SHS) were assessed.Results. The 1-year increase in the SHS correlated with the 1-month change in C2C results (r ‫؍‬ 0.311, P ‫؍‬ 0.028) and the ⌬COL score (r ‫؍‬ 0.342, P ‫؍‬ 0.015). Radiographic progression was predicted by increases in serum C2C at 1 month (P ‫؍‬ 0.031). The ⌬COL score was significantly associated with 1-year radiographic progression after 1 (P ‫؍‬ 0.022), 3 (P ‫؍‬ 0.015), 6 (P ‫؍‬ 0.048), and 9 (P ‫؍‬ 0.019) months of therapy. Clinical remission was predicted by 1-month decreases in serum levels of C2C (P ‫؍‬ 0.008) and C1,2C (P ‫؍‬ 0.036). By regression analysis, 1-month changes in C2C, C1,2C, and CPII levels were independently associated with, and correctly predicted radiographic outcome in, 88% of the patients.Conclusion. Short-term changes in serum levels of collagen biomarkers following initiation of biologic therapy may better predict long-term clinical and radiographic outcomes. These collagen biomarkers may therefore be valuable new early indicators of short-term biologic treatment efficacy in clinical trials and in individual patients with inflammatory erosive arthritis.Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are forms of progressive inflammatory arthritis characterized by pain and progressive destruction of the joints. Joint destruction occurs when inflamed synovial tissue erodes and degrades adjacent cartilage and bone through the action of locally produced cytokines and metalloproteinases (1). This process can be measured by quantifying the changes in joint space narrowing and erosions that are visible on serial plain radiographs (2). Radiographic joint damage is associated with long-term functional disability (3) and is the accepted assessment tool for monitoring clinical progression and long-term response to therapy (4). Radiographic progression develops over many months and years, however, and is not suitable for assessment of treatment efficacy over short periods.