Radiographic progression and remission rates in early rheumatoid arthritis - MRI bone oedema and anti-CCP predicted radiographic progression in the 5-year extension of the double-blind randomised CIMESTRA trial.
OBJECTIVE
At 5 years' follow-up of early (<6 months) rheumatoid arthritis patients to (1) investigate whether initial combination therapy with methotrexate (MTX) and ciclosporin (CSA) (n=80) is superior to initial monotherapy with MTX (n=80) with respect to prevention of radiographic progression, (2) investigate whether the favourable clinical and radiographic response reported at 2 years in the CIMESTRA trial can be maintained and (3) identify predictors of radiographic outcome.


METHODS
139 patients completed 5 years' follow-up with maintained double-blinding and a strict synovitis suppressive treatment strategy with intra-articular betamethasone injections (intra-articular glucocorticosteroid (GC)) and escalation of disease-modifying anti-rheumatic drug treatment. Disease activity, total Sharp-van der Heijde Score (TSS) of hands, wrists and forefeet were assessed at baseline and after 3, 4 and 5 years. MRI of the wrist and anti-cyclic citrullinated peptide (anti-CCP) were assessed at baseline.


RESULTS
At 5 years, TSS progression rate was <1 unit/year and 47% had not progressed radiographically since baseline. 78% were in Disease Activity Score remission, 56% in American College of Rheumatology remission and 17% withdrawn from treatment due to remission. There were no differences between initial treatment groups. MRI-bone marrow oedema, TSS and anti-CCP predicted radiographic progression at 5 years.


CONCLUSIONS
Early and strict synovitis suppressive treatment with MTX and intra-articular GC lead to high remission rates and halting of erosive progression at 5 years. No additional effect of initial combination therapy with CSA was found. The results parallel those reported for tumour necrosis factor α antagonists. Baseline MRI-bone oedema, TSS and anti-CCP predicted radiographic progression.
Hetland
Merete L
ML
Department of Rheumatology, Copenhagen University Hospital, Hvidovre and Glostrup, Denmark.
Stengaard-Pedersen
Kristian
K
Junker
Peter
P
Østergaard
Mikkel
M
Ejbjerg
Bo J
BJ
Jacobsen
Søren
S
Lottenburger
Tine
T
Hansen
Ib
I
Tarp
Ulrik
U
Andersen
Lis S
LS
Svendsen
Anders
A
Pedersen
Jens K
JK
Lauridsen
Ulrik B
UB
Ellingsen
Torkell
T
Lindegaard
Hanne
H
Pødenphant
Jan
J
Vestergaard
Aage
A
Jurik
Anne Grethe
AG
Hørslev-Petersen
Kim
K
D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001855:Bone Marrow Diseases / Q000175:diagnosis / Q000209:etiology*; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use; D018450:Disease Progression; D004359:Drug Therapy, Combination; D004487:Edema / Q000175:diagnosis / Q000209:etiology*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology*; D011379:Prognosis; D011859:Radiography; D012074:Remission Induction
D018501:Antirheumatic Agents; D001323:Autoantibodies; D015415:Biomarkers; D007166:Immunosuppressive Agents; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D016572:Cyclosporine; D008727:Methotrexate