Early clinical response and long-term radiographic progression in recent-onset rheumatoid arthritis: Clinical remission within six months remains the treatment target - 17/04/19

Doi : 10.1016/j.jbspin.2019.03.008

Julie Legrand ^a,^b,^{^{1
Julie Legrand et Thomas Kirchgesner contributed equally to this work.}}, Thomas Kirchgesner ^a,^b,^{^{1
Julie Legrand et Thomas Kirchgesner contributed equally to this work.}}, Tatiana Sokolova ^b,^c, Bruno Vande Berg ^a,^b, Patrick Durez ^b,^c,^⁎
^a Service de radiologie, Cliniques universitaires Saint-Luc, 1200 Bruxelles, Belgium
^b Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), 1200 Bruxelles, Belgium
^c Service de rhumatologie, Cliniques universitaires Saint-Luc, 1200 Bruxelles, Belgium

^⁎Corresponding author at: Service de rhumatologie, Cliniques universitaires Saint-Luc, 10, avenue Hippocrate, 1200 Bruxelles, BelgiumService de rhumatologie, Cliniques universitaires Saint-Luc10, avenue HippocrateBruxelles1200Belgium

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Abstract

Objectives

The primary objective was to evaluate the correlation between 5-year radiographic structural disease progression and early clinical remission in recent-onset rheumatoid arthritis (RA). The secondary objective was to assess the correlation between erosion development in joints free of damage at baseline and early clinical remission.

Methods

A single-center retrospective study was performed in 133 patients meeting ACR criteria for RA of recent onset. Two radiologists independently quantified radiographic structural lesions at the hands and forefeet using the Sharp van der Heijde (SVdH) Score at the diagnosis then 5 years later. The patients were divided into two groups based on whether the lesions were stable (SVdH Score increase ≤ 10 points, Xray-STAB group) or had worsened (SVdH Score increase > 10 points, Xray-PROG group). The clinical response was assessed after 3, 6, and 12 months. Clinical remission was defined based on the DAS28-CRP, SDAI, CDAI, and ACR/EULAR Boolean remission criteria.

Results

Of the 133 patients, 90 were in the Xray-STAB group (mean SVdH score increase, 2.4 ± 2.9) and 43 in the Xray-PROG group (22.9 ± 13.4). The 6-month disease activity indices were higher in the Xray-PROG group (P < 0.05). Achieving a 6-month clinical remission had 58.6%, 39.1%, 40.0%, and 32.2% sensitivity for predicting 5-year radiographic stability when the DAS28-CRP, SDAI, CDAI, and Boolean definition were used, respectively; corresponding values for specificity were 73.8%, 85.7%, 83.7%, and 90.5%.