Existing joint erosions increase the risk of joint space narrowing independently of clinical synovitis in patients with early rheumatoid arthritisReport as inadecuate




Existing joint erosions increase the risk of joint space narrowing independently of clinical synovitis in patients with early rheumatoid arthritis - Download this document for free, or read online. Document in PDF available to download.

Arthritis Research and Therapy

, 17:133

First Online: 21 May 2015Received: 30 July 2014Accepted: 16 April 2015

Abstract

IntroductionClinical synovitis is often associated with damage to bone and cartilage. Previous data have suggested that joint erosions JE are more prevalent than joint space narrowing JSN and that the two processes are partly independent of each other. The objective of this study was to evaluate whether the presence of JE in an individual joint can lead to development of JSN and if existing JSN leads to new onset of JE, in the absence of synovitis.

MethodsThe Prospective Multi-Centre Randomised, Double-Blind, Active Comparator-Controlled, Parallel-Groups Study Comparing the Fully Human Monoclonal Anti-TNFα Antibody Adalimumab Given Every Second Week With Methotrexate Given Weekly and the Combination of Adalimumab and Methotrexate Administered Over 2 Years in Patients With Early Rheumatoid Arthritis PREMIER enrolled early rheumatoid arthritis RA patients who were randomized to one of three treatments: methotrexate MTX, adalimumab ADA, or ADA + MTX. All evaluable joints with JE and JSN measures at 26 and 52 weeks and synovitis assessments from week 26 to 52 were included. Synovitis was assessed every 2–8 weeks by swollen joint counts between weeks 26 and 52. Radiographs were taken at week 26 and 52. Two readers, blinded to time and sequence, scored 14 bilateral joints individually for JE and JSN. Multivariate logistic modeling was used to characterize the dependence of JE-JSN onset at 52 weeks. Analyses were performed based on treatment arm and were also performed within individual joints.

ResultsJE and swelling were independently and comparably associated with onset of JSN at week 52. Assessment by individual joints indicated that existing JE, independent of swelling, was significantly associated with JSN onset in higher proportions of metatarsophalangeal MTP; 7-10 than proximal interphalangeal PIP; 1-8 or metacarpophalangeal MCP; 1-10 joints. Treatment with ADA + MTX prevents JE-JSN progression independently of its ability to suppress synovitis and limits JE-JSN onset and progression in joints with existing damage.

ConclusionsExisting JE predisposes individual joints to development of JSN independently of synovitis in the same joint. Weight-bearing MTP joints with JE may be at increased risk for JSN when compared with MCPs and PIPs.

Trial registrationClinicaltrials.gov NCT00195663. Registered 13 September 2005.

AbbreviationsADAadalimumab

CRPC-reactive protein

DAS2828-joint disease activity score

DMARDsdisease-modifying antirheumatic drugs

HAQ-DIdisability index of the health assessment questionnaire

JEjoint erosion

JSNjoint space narrowing

MCPmetacarpophalangeal

MTPmetatarsophalangeal

mTSSmodified total Sharp score

MTXmethotrexate

PIPproximal interphalangeal

PREMIERProspective Multi-Centre Randomised, Double-Blind, Active Comparator-Controlled, Parallel-Groups Study Comparing the Fully Human Monoclonal Anti-TNFα Antibody Adalimumab Given Every Second Week With Methotrexate Given Weekly and the Combination of Adalimumab and Methotrexate Administered Over 2 Years in Patients With Early Rheumatoid Arthritis

RArheumatoid arthritis

SJCswollen joint count

TJCtender joint count

TNFtumor necrosis factor

Electronic supplementary materialThe online version of this article doi:10.1186-s13075-015-0626-1 contains supplementary material, which is available to authorized users.

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Author: Robert Landewé - Josef S Smolen - Stefan Florentinus - Su Chen - Benoît Guérette - Désirée van der Heijde

Source: https://link.springer.com/







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