Background/Purpose:

The aim of treatment of rheumatoid arthritis is to control disease activity and to inhibit joint damage. Progression of damage is analysed by conventional radiographs. High radiographic progression has, to our knowledge, not been analysed in detail.

Objectives: To analyse RA patients depending on their individual peak radiographic progression.

Methods: We selected for the highest (peak) radiographic progression in every individual patient of the Swiss registry SCQM with at least two scored sets of radiographs of hands and feet. The individual radiographic progression was analysed as change of Ratingen erosion scores/year (follow up 1998 – 2015). The baseline disease characteristics were compared using standard descriptive statistics (Kruskal-Wallis or Chi-square tests). The change of DAS 28 and HAQ-DI scores before and after peak progression was analysed with the Wilcoxon signed rank tests.

Results:

Of the 4’033 patients in the analysis 3’049 patients had a peak radiographic progression rate between 0 and ≤10/year, 773 between 10 and ≤20, 150 between 20 and ≤30, and 61 of >30 (defining groups 1-4). Rheumatoid factor and ACPA were more frequent in patient groups with higher peak radiographic progression (RF: 73.6, 80.0, 88.9, 90.0; ACPA: 66.8, 73.4, 74.3, 82.1, groups 1-4, respectively). Peak radiographic progression at a rate >20/year (groups 3 and 4) were not detected after December 2012. When the rate of radiographic progression before and after peak progression was analysed, 69.7%, 74.7%, 76.9%, and 93.3% of the patients had a radiographic progression of 25% or lower as compared to peak progression before and 76.1%, 81.8%, 91.1%, and 93.8% after this peak progression, respectively for patients in groups 1 to 4 (Figure A).

The disease activity, as assessed by DAS 28, was significantly higher in all patient groups before peak progression and lower thereafter (p < 0.001). Average HAQ-DI scores increased after peak radiographic progression in group 4 (p = 0.005) whereas it is stable or even decreases among the patients of the other patient groups.

Conclusion: These data show that high radiographic progression is rare and gets less frequent over the last years. Higher disease activity precedes radiographic peak progression. Radiographic progression before and after the individual peak radiographic progression was far lower as compared to the time of radiographic peak progression. Only the highest individual peak (change of Ratingen score >30/year) radiographic progression was followed by an increase of HAQ-DI scores.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/only-very-high-radiographic-progression-affects-haq-di-results-from-the-swiss-scqm-cohort/