For patients with rheumatoid arthritis (RA) treated with biological disease-modifying antirheumatic drugs (bDMARDs), disease stage, health assessment questionnaire (HAQ) score at 18 months, and Larsen grade (LG) of joints at the start of treatment may be predictive of radiographic progression of damage (RPD) to large joints after 3 to 4 years of treatment, according to a study published in Modern Rheumatology.

These results indicate that bDMARDs may be more effective when started before disease stage and LG exceed III and that clinicians should develop a therapeutic strategy to prevent a score on the HAQ from exceeding 1.0 during treatment.

The study included participants with RA who were receiving bDMARDs for 3 to 4 years or who had achieved bDMARD-free status (n=71). The mean age and disease duration at the initiation of bDMARDs were 62.4 years and 10.8 years, respectively. The researchers evaluated 314 joints, including shoulders, elbows, hips, knees, and ankles. To determine whether RPD was present, they compared radiographs of the joints before and after treatment.


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The researchers observed RPD in 24 participants (33.8%) and 34 joints (10.8%). Joints that had an LG ≥III had significantly higher rates of RPD compared with joints with LGs I and II.

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Disease stage and HAQ score at 18 months were found to be independent risk factors for RPD (odds ratio [OR], 7.222 for disease stage; OR, 6.278 for HAQ at 18-month) in a multivariate logistic regression analysis.

“This clinically shows that HAQ score at 18-month is more important than baseline HAQ score for prevention of RPD to large joints and that bDMARD therapeutic strategy should be determined so that the HAQ score at 18 months does not exceed 1.0,” the researchers wrote.

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Reference

Nakajima A, Terayama K, Sonobe M, et al. Predictive factors for radiographic progression of large joint damage in patients with rheumatoid arthritis treated with biological disease-modifying antirheumatic drugs (bDMARDs): results of 3 to 4 years of follow-up [published online October 4, 2018]. Mod Rheumatol. doi:10.1080/14397595.2018.1532544