Arata Nakajima1,2, Keiichiro Terayama3, Masato Sonobe1, Yasuchika Aoki4,5, Hiroshi Takahashi1, Yorikazu Akatsu1, Shinji Taniguchi1, Manabu Yamada1, Ayako Kubota6, Koichi Nakagawa1. 1. Departments of Orthopaedics, Toho University Sakura Medical Center, Chiba, Japan. 2. Departments of Rheumatology, Toho University Sakura Medical Center, Chiba, Japan. 3. Departments of Rehabilitation, Toho University Sakura Medical Center, Chiba, Japan. 4. Department of General Medical Sciences, Graduate School of Medicine, Chiba University, Chiba, Japan. 5. Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Chiba, Japan. 6. Department of Orthopaedics, Toho University Omori Medical Center, Tokyo, Japan.
Abstract
Objectives: Little information is available regarding long-term follow-up of radiographic progression of damage (RPD) to large joints during treatment of rheumatoid arthritis (RA) with biological disease-modifying antirheumatic drugs (bDMARDs). We evaluated 3- to 4-year follow-up results and the associations between RPD and patient background and Larsen grade (LG) of joints. Methods: Seventy-one RA patients receiving bDMARDs for 3 to 4 years or who achieved bDMARD-free status were included. The mean age and disease duration at the start of bDMARDs were 62.4 years and 10.8 years, respectively. A total of 314 joints, including shoulders, elbows, hips, knees, and ankles, were evaluated to determine whether RPD was present by comparing radiographs before and after treatment. Results: RPD was observed in 24 patients (33.8%) and 34 joints (10.8%). Joints with an LG of III or higher had significantly higher rates of RPD than those with LGs I and II. Multivariate logistic regression analysis revealed that stage and health assessment questionnaire (HAQ) score at 18-months were independent risk factors for RPD (cut-off value: 2.5, odds ratio: 7.222 for stage; cut-off value: 0.9375, odds ratio: 6.278 for HAQ at 18-months). Conclusion: Stage, HAQ at 18-months, and LG at the start of bDMARDs were predictive of RPD after 3 to 4 years. bDMARDs should be started before both stage and LG exceed III and the therapeutic strategy should be determined so that HAQ does not exceed 1.0 during treatment.
Objectives: Little information is available regarding long-term follow-up of radiographic progression of damage (RPD) to large joints during treatment of rheumatoid arthritis (RA) with biological disease-modifying antirheumatic drugs (bDMARDs). We evaluated 3- to 4-year follow-up results and the associations between RPD and patient background and Larsen grade (LG) of joints. Methods: Seventy-one RApatients receiving bDMARDs for 3 to 4 years or who achieved bDMARD-free status were included. The mean age and disease duration at the start of bDMARDs were 62.4 years and 10.8 years, respectively. A total of 314 joints, including shoulders, elbows, hips, knees, and ankles, were evaluated to determine whether RPD was present by comparing radiographs before and after treatment. Results: RPD was observed in 24 patients (33.8%) and 34 joints (10.8%). Joints with an LG of III or higher had significantly higher rates of RPD than those with LGs I and II. Multivariate logistic regression analysis revealed that stage and health assessment questionnaire (HAQ) score at 18-months were independent risk factors for RPD (cut-off value: 2.5, odds ratio: 7.222 for stage; cut-off value: 0.9375, odds ratio: 6.278 for HAQ at 18-months). Conclusion: Stage, HAQ at 18-months, and LG at the start of bDMARDs were predictive of RPD after 3 to 4 years. bDMARDs should be started before both stage and LG exceed III and the therapeutic strategy should be determined so that HAQ does not exceed 1.0 during treatment.
Entities:
Keywords:
biological disease-modifying antirheumatic drugs (bDMARDs); large joints; predictive factors; radiographic progression of damage; rheumatoid arthritis
Authors: K Doi; H Ito; T Tomizawa; K Murata; M Hashimoto; M Tanaka; K Murakami; K Nishitani; M Azukizawa; A Okahata; M Saito; T Mimori; S Matsuda Journal: Medicine (Baltimore) Date: 2019-11 Impact factor: 1.817