title: Radiographic changes and factors associated with subsequent progression of damage in weight-bearing joints of patients with rheumatoid arthritis under TNF-blocking therapies-three-year observational study.
abstract: OBJECTIVE
  The long-term effects of tumor necrosis factor (TNF)-blocking therapies on weight-bearing joints in patients with rheumatoid arthritis (RA) have not been fully characterized. The purpose of this study was to assess the radiographic changes of weight-bearing joints in patients with RA during 3-year of TNF-blocking therapies and to identify factors related to the progression of joint damage.
  
  
  METHODS
  Changes in clinical variables and radiological findings in 243 weight-bearing joints (63 hips, 54 knees, 71 ankles, and 55 subtalar joints) in 38 consecutive patients were investigated during three years of treatment with TNF-blocking agents. Multivariate logistic regression analysis was used to identify risk factors for the progression of weight-bearing joint damage.
  
  
  RESULTS
  Seventeen (14.5%) of proximal weight-bearing joints (hips and knees) showed apparent radiographic progression during three years of treatment, whereas none of the proximal weight-bearing joints showed radiographic evidence of improvement or repair. In contrast, distal weight-bearing joints (ankle and subtalar joints) displayed radiographic progression and improvement in 20 (15.9%) and 8 (6.3%) joints, respectively. Multivariate logistic analysis for proximal weight-bearing joints identified the baseline Larsen grade (p < 0.001, OR:24.85, 95%CI: 5.07-121.79) and disease activity at one year after treatment (p = 0.003, OR:3.34, 95%CI:1.50-7.46) as independent factors associated with the progression of joint damage. On the other hand, multivariate analysis for distal weight-bearing joints identified disease activity at one year after treatment (p < 0.001, OR:2.13, 95%CI:1.43-3.18) as an independent factor related to the progression of damage.
  
  
  CONCLUSIONS
  Baseline Larsen grade was strongly associated with the progression of damage in the proximal weight-bearing joints. Disease activity after treatment was an independent factor for progression of damage in proximal and distal weight-bearing joints. Early treatment with TNF-blocking agents and tight control of disease activity are necessary to prevent the progression of damage of the weight-bearing joints.
authors: a Department of Orthopaedic Surgery, Faculty of Medicine , University of Toyama , Toyama , Japan.
authors: Isao
authors: I
authors: Matsushita
authors: a Department of Orthopaedic Surgery, Faculty of Medicine , University of Toyama , Toyama , Japan.
authors: Hiraku
authors: H
authors: Motomura
authors: a Department of Orthopaedic Surgery, Faculty of Medicine , University of Toyama , Toyama , Japan.
authors: Eiko
authors: E
authors: Seki
authors: a Department of Orthopaedic Surgery, Faculty of Medicine , University of Toyama , Toyama , Japan.
authors: Tomoatsu
authors: T
authors: Kimura
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007596:Joints / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D016474:Weight-Bearing
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
keywords: Etanercept; Infliximab; Radiographic progression; Rheumatoid arthritis; TNF-blocking therapy; Weight-bearing joint