TRENDS IN DISEASE ACTIVITY, FUNCTIONAL STATUS, AND RADIOGRAPHIC CHANGES IN EARLY RHEUMATOID ARTHRITIS: RESULTS OF A 5-YEAR FOLLOW-UP WITHIN THE RUSSIAN RADIKAL PROGRAM

Objective: to assess trends in disease activity, functional status, and radiographic changes, and their relationships in patients with early rheumatoid arthritis (RA).
Subjects and methods. The investigation enrolled 200 patients with early RA included in the RADIKAL (Early arthritis: diagnosis, outcomes, criteria, active treatment) program in the period 2003 to 2007. The duration of the disease at inclusion was <2 years. RA diagnosis fulfilled the 1987 American College of Rheumatology (ACR) criteria. Rheumatoid factor was found in 67.5% of the patients and anti-cyclic citrullinated peptide antibodies were detected in 57%. 86.5% of patients were female; median age was 49 [40; 58] years. The patients received traditional disease-modifying antirheumatic drugs and biological agents (24%). Monitoring was made according to the tight control principle. Determination of main clinical and laboratory parameters, DAS28, HAQ disability index (DI) and functional class, as well as hands and feet X-ray were done every year.
Results. There was stabilization of RA activity and functional status over 5 years. Median DAS28 at inclusion was 5.1 [4.49; 5.85], that after 1, 2, 3, 4, and 5 years was 3.05 [2.25; 4.43], 3.04 [2.07; 4.23], 2.55 [1.86; 3.74], 2.48 [1.78; 3.77], and 3.12 [1.86; 4.32], respectively. Median HAQ DI was 1.125 [0.625; 1.75], 0.5 [0.125; 1.0], 0.5 [0; 1.0], 0.5 [0; 1.0], 0.5 [0; 1.0], and 0.75 [0.125; 1.125], respectively. During the entire follow-up period, there was a stable positive correlation between DAS28 and HAQ DI (r = 0.61–0.77). Despite reductions in DAS28 and HAQ DI, destruction progressed. Joint erosions were seen in 16% of the patients at inclusion; and in 27.5, 38.5, 49.5, 58, and 73% at 1-, 2-, 3-, 4-, and 5-year of follow-up, respectively.
Conclusion. The found positive correlation between DAS28 and HAQ DI suggests that lower RA activity has a favorable impact on the functional status of patients. However, irreversible structural joint changes continue to develop in the presence of persistent RA course, which can cause a higher HAQ score that may be noted after 5 years of follow-up. 

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