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X-RAY PROGRESSION AND ITS IMPACT ON THE FUNCTIONAL STATUS OF PATIENTS WITH EARLY RHEUMATOID ARTHRITIS DURING A 5-YEAR FOLLOW-UP

https://doi.org/10.14412/1995-4484-2015-274-280

Abstract

Objective: to assess progression of X-ray joint changes and their impact on functional status of patients with early rheumatoid arthritis (RA).

Subjects and methods. The investigation enrolled 204 patients with early RA included in the RADICAL (Early Arthritis: Diagnosis, Outcomes, Criteria, Active Treatment) program in the period 2003 to 2007. The duration of the disease at the inclusion was less than 2 years. RA was diagnosed according to 1987 American College of Rheumatology (ACR) criteria. Rheumatoid factor was presentin 67.5% of the patients and anti-cyclic citrullinated peptide antibodies – in 57%. Women were 86.5%; median age was 49 [40; 58] years. The patients received traditional diseasemodifying antirheumatic drugs and biological agents (24%). Therapy response was monitored applying the tight control strategy. Main clinical and laboratory parameters, DAS28, and HAQ scores, and functional class and hand and foot X-ray were recorded every year.

Results and discussion. After 5 years of follow-up, new erosions appeared in 57% of the patients. Joint erosions were present in 16.5% of the patients at the inclusion and in 73% following 5 years. At baseline, after 1, 2, 3, 4, and 5 years, the total erosion scores (modified Sharp score) was equal to 0 [0; 0], 0 [0; 1], 0 [0; 4], 1 [0; 8], 3 [0; 12], 6 [0; 14], respectively. A significant functional improvement could be achieved just during the first year of follow-up. Thus, the median HAQ value decreased from 1.125 [0.625; 1.75] to 0.5 [0.125; 1.0], reaching the population level. Following 2, 3, 4, and 5 years, the median HAQ was 0.5 [0; 1.0], 0.5 [0; 1.0], 0.5 [0; 1.0], and 0.75 [0.125; 1.125], respectively. There was a weak positive correlation between total erosion scores and HAQ in the eаrly stage of the disease. However, it became more marked after 3, 4, and 5 years (correlation coefficient, 0.38, 0.39, and 0.40,
respectively; p < 0.01). 

Conclusion.In spite of the stable pattern of disease course, structural damage progression was seen in patients with early RA. However, detailed erosive component assessment using the modified Sharp score showed that the structural changes were modest in the majority of patients and HAQ value during the first 4 years of follow-up were comparable with the population level, which may be indicative of a rather favorable functional prognosis. Five years later, there was an increasing correlation between total erosion scores and HAQ. This may be responsible for higher HAQ scores after 5 years of follow-up

About the Authors

Yu. A. Ermakova
V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia 34A, Kashirskoe Shosse, Moscow 115522
Russian Federation


D. E. Karateev
V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia 34A, Kashirskoe Shosse, Moscow 115522
Russian Federation


E. L. Luchikhina
V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia 34A, Kashirskoe Shosse, Moscow 115522
Russian Federation


N. V. Demidova
V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia 34A, Kashirskoe Shosse, Moscow 115522
Russian Federation


A. V. Smirnov
V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia 34A, Kashirskoe Shosse, Moscow 115522
Russian Federation


References

1. Van der Kooi E, Klarenbeek NB, Wolterbeek R, et al. The effect of a change in DAS level on the HAQ level at any given time: 5-year results from BeSt study. Ann Rheum Dis. 2009;68:3226.

2. Van der Kooi E, Klarenbeek NB, Gü er-Yü ksel M, et al. A decrease in disease activity score (DAS) level is associated with a decrease in Health Assessment Questionnaire (HAQ) score, independent of follow-up duration, during 5 years of tightly controlled treatment: results from BeSt study. Ann Rheum Dis. 2011 Jan;70(1):168–71. doi: 10.1136/ard.2010. Epub 2010 Nov 29.

3. Каратеев ДЕ. Основные тенденции и вариабельность эволюции ревматоидного артрита: результаты многолетнего наблюдения. Научно-практическая ревматология. 2004;(1):8–14 [Karateev DE. Main trends and variability evolution rheumatoid arthritis: results of long-term observation. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2004;(1):8–14 (In Russ.)].

4. Paco MJ, Welsing PM, Anke M, van der Gestel AM. The relationship between disease activity, joint destruction, and functional capacity over the course of rheumatoid arthritis. Arthritis Rheum. 2001;44(9):2009–17. doi: 10.1002/1529-0131(200109)44:9<2009::AID-ART349>3.0.CO;2-L

5. Scott DL, Pugner K, Kaarela K, et al. The links between joint damage and disability in rheumatoid arthritis. Rheumatology (Oxford). 2000 Feb;39(2):122–32. doi: 10.1093/rheumatology/ 39.2.122

6. Machold KP, Stamm TA, Nell VPK, et al. Very recent onset rheumatoid arthritis: clinical and serological patient characteristics associated with radiographic progression over the first years of disease. Rheumatology. 2007;46:342–9. doi: 10.1093/rheumatology/kel237

7. Каратеев ДЕ, Лучихина ЕЛ, Тюрина ЛН и др. Возможности ранней диагностики ревматоидного артрита в клинической практике на современном этапе (результаты наблюдений за московской когортой больных ранним артритом в рамках программы РАДИКАЛ). Терапевтический архив. 2008;(5):8–13 [Каратеev DE, Luchikhina EL, Tyurina LN, et al. Possibilities of early diagnosis of rheumatoid arthritis in clinical practice at the present stage (the results of observations of the Moscow cohort of patients with early arthritis in the framework of the RADICAL). Terapevticheskii arkhiv. 2008;(5):8–13 (In Russ.)].

8. Гусева ИА, Демидова НВ, Лучихина ЕЛ. Иммуногенетические и иммунологические маркеры раннего ревматоидного артрита (результаты первого этапа исследований по программе РАДИКАЛ), Научно- практическая ревматология. 2008;(6):17–26 [Guseva IA, Demidova NV, Luchikhina EL. Immunogenetic and immunological markers of early rheumatoid arthritis (the results of the first stage of the program of research on RADICAL). Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2008;(6):17–26 (In Russ.)].

9. Демидова НВ. Взаимосвязь иммуногенетических и иммунологических маркеров и их влияние на активность заболевания и рентгенологическое прогрессирование у больных ранним ревматоидным артритом. Научно- практическая ревматология. 2009;(3):12–7 [Demidova NV. Relationship immunogenetic and immunologic markers and their influence on disease activity and radiographic progression in patients with early rheumatoid arthritis. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2009;(3):12–7 (In Russ.)].

10. Van der Heijde D, Landewe R, van Vollenhoven R, et al. Level of radiographic damage and radiographic progression are determinants of physical function: a longitudinal analysis of the TEMPO trial. Ann Rheum. 2008;67:1267–70. doi: 10.1136/ard.2007.081331

11. Smolen JS, Aletaha D, Bijlsma JW, et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010 Apr;69(4):631–7. doi: 10.1136/ard.2009.123919

12. Bijlsma JW, Weinblatt ME. Optimal use of the methotrexate: the advantages of tight control. Ann Reum Dis. 2007;66:1409–10. doi: 10.1136/ard.2007.076463

13. Vermeer M, Kuper HH, Moens HJ, et al. Sustained beneficial effects of a protocolized treat-to-target strategy in very early rheumatoid arthritis: Three year results of the DREAM remission induction cohort. Arthritis Care Res (Hoboken). 2013 Aug;65(8):1219–26. doi: 10.1002/acr.21984

14. Grigor C, Carell H, Stirling A, et al. Effect of treatment strategy of tight control of rheumatoid arthritis (the TICORA study): a singleblind randomized controlled trial. Lancet. 2004;364:263–9. doi: 10.1016/S0140-6736(04)16676-2

15. American College of Rheumatology Ad Hoc Commiitee on Clinical Guidelines. Guidelines for monitoring drug therapy in rheumatoid arthritis. Arthritis Rheum. 1996;39:723–31. doi: 10.1002/art.1780390503

16. Chen M, Bombardier C, Li X, et al. Radiographic damage and radiographic progression are predictors for physical function: results from SONORA study. Ann Rheum Dis. 2009;68 Suppl 3:223.

17. Bruynesteyn K, Landewe R, van der Linden S, van der Heijde D. Radiography as primary outcome in rheumatoid arthritis: acceptable sample size for trials with 3 months follow up. Ann Rheum Dis. 2004;63(11):1413–8. doi: 10.1136/ard.2003.014043

18. Каратеев ДЕ, Иванова ММ. Базисная терапия ревматоидного артрита и исход болезни: ретроспективная оценка данных многолетнего наблюдения. Научно-практическая ревматология. 2001;(1):5–12 [Karateev DE, Ivanova MM. Basic therapy for rheumatoid arthritis, and the outcome of the disease: a retrospective evaluation of long-term observation data. Nauchnoprakticheskaya revmatologiya = Rheumatology Science and Practice. 2001;(1):5–12 (In Russ.)].

19. Brahee DD, Pierre-Jerome C, Kettner NW. Clinical and radiological manifestations of the rheumatoid wrist. A comprehensive review. J Manipul Phisiol Ther. 2003;26(5):323–9. doi: 10.1016/S0161-4754(03)00046-0

20. Emery P. Practical aspects of treatment RA, when, how, what is the evidence? Ann Rheum Dis. 2003;2:SP0001.

21. Combe B, Cantagrel A, Goupille P, et al. Predictive factors of 5-year health assessment questionnaire disability in early rheumatoid arthritis. J Rheumatol. 2003 Nov; 30(11):2344–9.

22. Nair S, Bijlsma J, Werf JHVD, et al. Disease activity as an important treatment target for rheumatoid arthritis direct and indirect effects on functional disability over the disease course and the influence of intensity of treatment. Ann Rheum Dis. 2012;71(3):107. doi: 10.1136/annrheumdis-2012-eular.1840

23. Courvoisier N, Dougados M, Cantagrel A, et al. Prognostic factors of 10-year radiographic outcome in early rheumatoid arthritis: a prospective study. Arthritis Res Ther. 2008;10(5):R106. doi: 10.1186/ar2498. Epub 2008 Sep 4.

24. Combe B, Dougados M, Goupille P, et al. Prognostic factors for radiographic damage in early rheumatoid arthritis. Arthritis Rheum. 2001;44(8):1736–43. doi: 10.1002/1529- 0131(200108)44:8<1736::AID-ART308>3.0.CO;2-I

25. Van den Broek M, Driven L, Klarenbeek N, et al. Clinical and radiological outcomes of four disease activity driven treatment strategies: 8-year results of the BEST study. Ann Rheum Dis. 2012;71(3):106. doi: 10.1136/annrheumdis-2012-eular.1837


Review

For citations:


Ermakova Yu.A., Karateev D.E., Luchikhina E.L., Demidova N.V., Smirnov A.V. X-RAY PROGRESSION AND ITS IMPACT ON THE FUNCTIONAL STATUS OF PATIENTS WITH EARLY RHEUMATOID ARTHRITIS DURING A 5-YEAR FOLLOW-UP. Rheumatology Science and Practice. 2015;53(3):274-280. (In Russ.) https://doi.org/10.14412/1995-4484-2015-274-280

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ISSN 1995-4484 (Print)
ISSN 1995-4492 (Online)