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Low disease activity or Remission: is this the question? Progression of structural damage in a cohort of RA patients in remission or low disease activity
Purpose : Low disease activity (LDA) and remission (REM) are the therapeutic objectives in rheumatoid arthritis (RA). However, studies have shown that structural damage may progress in such patients. Objective: To assess the risk of radiographic progression at 1 year in patients in either LDA or REM.
Method . Patients with established RA, satisfying to 1987 ACR criteria, were included between February 2007 and February 2008. Inclusion criteria were: RA diagnosis made after 2000, LDA or REM defined as DAS 44 ≤ 2.4 or < 1.6 respectively. All patients were assessed clinically every three months for 12 months. Hand and forefoot X-rays were performed at baseline and 12 months. At baseline, all patients underwent high resolution ultrasonography of the hands and forefeet (ESAOTE technos) and low-field dedicated MRI of the dominant hand (ESAOTE C-scan 0.2T). Structural damage was assessed with the van der Heijde-modified Sharp score (SHS), performed blindly by 2 trained readers aware of X-ray sequence. Progression was defined as a variation of the total SHS of at least 1 point.
Results
85 patients were included, 38 in LDA and 47 in REM. Main characteristics were: mean age 51 years; mean disease duration 2.9 years without significant differences between groups. At baseline, the main difference between LDA and REM groups was the presence of positive power Doppler on ultrasonography1.
The structural progression during the 12-month follow-up was not different between the 2 groups (table 1). There was a trend for higher number of progressors in the LDA than in the REM group (64.9 % versus 50%) although not significant.
Table 1
| LDA (n=47) | REM (n=38) | p |
Characteristics at baseline |
|
|
|
- Patients with ³ 1 synovitis on US, (%) | 86.5 | 89.4 | ns |
- Patients with positive PD, n (%) | 44.4 | 17.0 | 0.01 |
- Patients with ³ 1 synovitis on MRI, (%) | 95.7 | 97.0 | ns |
- Patients with ³ 1 BMO on MRI, (%) | 34.2 | 29.8 | ns |
Radiographic progression |
|
|
|
- Total SHS variation | 3.3
| 3.0
| ns
|
- Progressors, n (%) | 31 (64.9)
| 17 (50.0)
| ns
|
Conclusion .
Patients in LDA or REM don't seem to progress differently over a 1-year period. Further analyses are in progress to determine the impact of PD signal and BMO on radiographic progression.
1 Foltz V et al. Arthritis and rheum 2008;9 suppl:S468.