title: Impact of tumour necrosis factor inhibitor treatment on radiographic progression in rheumatoid arthritis patients in clinical practice: results from the nationwide Danish DANBIO registry.
abstract: OBJECTIVE
  To compare radiographic progression during treatment with disease-modifying antirheumatic drugs (DMARD) and subsequent treatment with tumour necrosis factor α inhibitors (TNF-I) in rheumatoid arthritis (RA) patients in clinical practice.
  
  
  METHODS
  Conventional radiographs (x-rays) of hands and wrists were obtained ∼2 years before start (prebaseline), at baseline and ∼2 years after start (follow-up) of TNF-I. Clinical data were obtained from the DANBIO registry and the patient files. x-Rays were scored blinded to chronology according to the Sharp/van der Heijde method. Annual radiographic progression rates during the DMARD (prebaseline to baseline x-ray) and TNF-I (baseline to follow-up x-ray) periods were calculated.
  
  
  RESULTS
  517 RA patients (76% women, 80% IgM rheumatoid factor positive, 65% anticyclic citrullinated peptide positive, 40% current smokers, age 54 years (range 21-86), median disease duration 5 years (range 0-57)) were included. Patients were treated with infliximab (61%), etanercept (15%) or adalimumab (24%). During the DMARD period 85% of patients received methotrexate, 51% sulphasalazine and 78% prednisolone. The median DMARD period was 733 days (IQR 484-1002) and the median TNF-I period was 562 days (IQR 405-766). The median radiographic progression rate decreased from 0.7 (IQR 0-2.9) total Sharp score units/year (dTSS) in the DMARD period to 0 (0-0.9) units/year in the TNF-I period (p<0.0001, Wilcoxon). Corresponding mean dTSS values were 2.1 (SD 3.7) versus 0.7 (SD 2.3) units/year (p<0.0001, paired t test). 305 patients progressed (dTSS >0) in the DMARD period compared with 158 patients in the TNF-I period (p<0.0001, χ(2)).
  
  
  CONCLUSIONS
  This nationwide observational study of RA patients documented significantly reduced radiographic progression during TNF-I treatment compared with the previous period of DMARD treatment.
authors.affiliation: Department of Rheumatology, Copenhagen University Hospital Glostrup, Glostrup, Denmark. lykke@oernbjerg.dk
authors.forename: Lykke Midtbøll
authors.initials: LM
authors.lastname: Ornbjerg
authors.forename: Mikkel
authors.initials: M
authors.lastname: Ostergaard
authors.forename: Pernille
authors.initials: P
authors.lastname: Bøyesen
authors.forename: Niels Steen
authors.initials: NS
authors.lastname: Krogh
authors.forename: Anja
authors.initials: A
authors.lastname: Thormann
authors.forename: Ulrik
authors.initials: U
authors.lastname: Tarp
authors.forename: Uta Engling
authors.initials: UE
authors.lastname: Poulsen
authors.forename: Jakob
authors.initials: J
authors.lastname: Espesen
authors.forename: Vibeke Stevenius
authors.initials: VS
authors.lastname: Ringsdal
authors.forename: Niels
authors.initials: N
authors.lastname: Graudal
authors.forename: Gina
authors.initials: G
authors.lastname: Kollerup
authors.forename: Dorte Vendelbo
authors.initials: DV
authors.lastname: Jensen
authors.forename: Ole Rintek
authors.initials: OR
authors.lastname: Madsen
authors.forename: Bente
authors.initials: B
authors.lastname: Glintborg
authors.forename: Torben
authors.initials: T
authors.lastname: Christensen
authors.forename: Hanne
authors.initials: H
authors.lastname: Lindegaard
authors.forename: Ditte
authors.initials: D
authors.lastname: Dencker
authors.forename: Annette
authors.initials: A
authors.lastname: Hansen
authors.forename: Anne Rødgaard
authors.initials: AR
authors.lastname: Andersen
authors.forename: Merete Lund
authors.initials: ML
authors.lastname: Hetland
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology*; D003718:Denmark; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012042:Registries; D012189:Retrospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha