Clinical and radiological disease-course in a Swedish DMARD-treated early RA-inception cohort: an observational study.
OBJECTIVE
Disease-modifying anti-rheumatic drugs (DMARDs) decrease clinical signs and symptoms in rheumatoid arthritis (RA). However, radiographic changes sometimes continue to accrue despite effective suppression of clinical symptoms by therapy. The objective of this study was to identify whether successful clinical disease-control in a Swedish early RA-inception cohort of patients led to an attenuation of radiological progression.


METHODS
We analysed clinical data and radiographs of 95 patients who were on a stable treatment regimen [methotrexate (MTX), sulfasalazine (SSZ), oral gold (AUR)] or who had changed between different DMARDs during the 2-year observation period [multiple therapy failures (mTF)]. Radiographs were quantified using the modified Larsen score and 'X-Ray RheumaCoach' software.


RESULTS
Clinical measures improved markedly (p <0.001) from baseline to year 2 under AUR, MTX, and SSZ therapy but not in the mTF group. Similar levels of disease control were seen for each DMARD. During this period, patients treated with AUR had a deltaLarsen score (+ 14.5+/-1.3) similar to mTF patients (+ 15.8+/-1.1) but greater than patients on MTX (+8.6+/-0.8) or SSZ (+9.1+/-0.8).


CONCLUSIONS
This study confirms that radiological progression occurs despite a clinically acceptable disease control, but also shows that, given the same degree of clinical disease control, radiological progression can be different for different DMARDs.
Wick
M C
MC
Department of Medicine at Karolinska University Hospital, Stockholm, Sweden. marius.wick@uibk.ac.at
Lindblad
S
S
Weiss
R J
RJ
Klareskog
L
L
van Vollenhoven
R F
RF
D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D015331:Cohort Studies; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006052:Gold Sodium Thiomalate / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D010147:Pain Measurement; D011379:Prognosis; D011859:Radiography; D012042:Registries; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012460:Sulfasalazine / Q000627:therapeutic use; D013548:Sweden; D016896:Treatment Outcome
D018501:Antirheumatic Agents; D006052:Gold Sodium Thiomalate; D012460:Sulfasalazine; D008727:Methotrexate