Daniel F McWilliams1, Michelle Marshall2, Keeranur Jayakumar3, Sally Doherty4, Michael Doherty5, Weiya Zhang5, Patrick D W Kiely6, Adam Young7, David A Walsh8. 1. Arthritis Research UK Pain Centre, Division of ROD Division of ROD, University of Nottingham, UK dan.mcwilliams@nottingham.ac.uk. 2. Arthritis Research UK Primary Care Centre, Keele University, Keele. 3. Department of Rheumatology, Heart of England NHS Foundation Trust, Birmingham. 4. Division of ROD, University of Nottingham, UK. 5. Arthritis Research UK Pain Centre, Division of ROD Division of ROD, University of Nottingham, UK. 6. Department of Rheumatology, St Georges Healthcare NHS Trust, London. 7. Department of Rheumatology, West Hertfordshire Hospitals NHS Trust, St Albans. 8. Arthritis Research UK Pain Centre, Division of ROD Division of ROD, University of Nottingham, UK Department of Rheumatology, Sherwood Forest Hospitals NHS Foundation Trust, Sutton in Ashfield, UK.
Abstract
OBJECTIVES: To investigate factors associated with joint damage in early RA, and how comorbid OA might influence patient assessment and outcomes. METHODS:Baseline radiographs of hands and feet from 512 participants in the Early RA Network cohort, and after 3 (±1) years, 166 of those participants yieldedcomplete scores for RA [erosions, joint space narrowing (JSN)] and OA [JSN, osteophytes (OST)] using validated atlases. DAS28-P is the proportion of DAS28 attributed to patient-reported factors. Adjusted odds ratios were calculated using logistic regression. RESULTS:OA was common at baseline in early RA (40% hand and 48% foot) and associated with RA radiographic score. Higher baseline RA scores were associated with increasing age and ESR, and lower DAS28-P. OST scores were associated with higher age. DAS28 and patient-reported outcomes improved, whereas RA and OA radiographic scores deteriorated by follow-up. Erosive progression was predicted by higher baseline erosions, female gender, better mental health and lower DAS28-P. Hand OST progression was predicted by baseline OST scores. Inflammatory disease activity was associated with erosive, but not with OA progression. Baseline hand OA predicted worse physical function at follow-up, but radiographic progression did not explain changes in patient-reported outcomes. CONCLUSION:OA is a common comorbidity that might confound radiographic and clinical assessment, but does not fully explain erosive progression or patient-reported outcomes in early RA. Early RA management should address psychosocial factors and comorbidities, as well as joint inflammation.
RCT Entities:
OBJECTIVES: To investigate factors associated with joint damage in early RA, and how comorbid OA might influence patient assessment and outcomes. METHODS: Baseline radiographs of hands and feet from 512 participants in the Early RA Network cohort, and after 3 (±1) years, 166 of those participants yielded complete scores for RA [erosions, joint space narrowing (JSN)] and OA [JSN, osteophytes (OST)] using validated atlases. DAS28-P is the proportion of DAS28 attributed to patient-reported factors. Adjusted odds ratios were calculated using logistic regression. RESULTS: OA was common at baseline in early RA (40% hand and 48% foot) and associated with RA radiographic score. Higher baseline RA scores were associated with increasing age and ESR, and lower DAS28-P. OST scores were associated with higher age. DAS28 and patient-reported outcomes improved, whereas RA and OA radiographic scores deteriorated by follow-up. Erosive progression was predicted by higher baseline erosions, female gender, better mental health and lower DAS28-P. Hand OST progression was predicted by baseline OST scores. Inflammatory disease activity was associated with erosive, but not with OA progression. Baseline hand OA predicted worse physical function at follow-up, but radiographic progression did not explain changes in patient-reported outcomes. CONCLUSION: OA is a common comorbidity that might confound radiographic and clinical assessment, but does not fully explain erosive progression or patient-reported outcomes in early RA. Early RA management should address psychosocial factors and comorbidities, as well as joint inflammation.
Authors: Alexander Lautwein; Benedikt Ostendorf; Stefan Vordenbäumen; Aiko Liedmann; Ralph Brinks; Mario Giulini; Sarah Ohrndorf; Marina Backhaus; Hasan Acar; Oliver Sander; Jutta G Richter; Matthias Schneider; Philipp Sewerin Journal: Adv Rheumatol Date: 2022-01-04
Authors: Désirée van der Heijde; Patrick Durez; Georg Schett; Esperanza Naredo; Mikkel Østergaard; Gabriella Meszaros; Francesco De Leonardis; Inmaculada de la Torre; Pedro López-Romero; Douglas Schlichting; Eric Nantz; Roy Fleischmann Journal: Clin Rheumatol Date: 2018-08-04 Impact factor: 2.980
Authors: Daniel F McWilliams; Shimin Rahman; Richard J E James; Eamonn Ferguson; Patrick D W Kiely; Adam Young; David A Walsh Journal: BMC Rheumatol Date: 2019-11-18
Authors: Daniel F McWilliams; Divya Thankaraj; Julie Jones-Diette; Rheinallt Morgan; Onosi S Ifesemen; Nicholas G Shenker; David A Walsh Journal: Rheumatology (Oxford) Date: 2021-12-24 Impact factor: 7.580