Characteristic of the Japanese Patients with Rheumatoid Arthritis (RA) of Rapid Radiographic Progression (RRP) Treated with Synthetic Disease Modifying Anti-Rheumatic Drugs (DMARDs) in Daily Practice: A Large-Scale Prospective Longitudinal Cohort Study (the 1st report of Apple Survey)

Akitomo Okada¹, Atsushi Kawakami², Takaaki Fukuda³, Toshihiko Hidaka⁴, Tomonori Ishii⁵, Yukitaka Ueki⁶, Takao Kodera⁷, Munetoshi Nakashima⁸, Yuichi Takahashi⁹, Seiyo Honda¹⁰, Yoshiro Horai², Tomohiro Koga¹, Ryu Watanabe¹¹, Hiroshi Okuno¹² and Katsumi Eguchi¹³, ¹Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan, ²Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan, ³Center for Rheumatic Diseases, Kurume University Medical Center, Kurume, Japan, ⁴Zenjinkai Shimin-No-Mori Hospital, Miyazaki, Japan, ⁵Department of Hematology and Rheumatology, Tohoku University, Sendai, Japan, ⁶Sasebo Chuo Hospital, Sasebo, Japan, ⁷Tohoku Kosei Nenkin Hospital, Sendai, Japan, ⁸Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan, ⁹Yu Family Clinic, Sendai, Japan, ¹⁰Kurume University School of Medicene, Kurume, Japan, ¹¹Department of Hematology and Rheumatology, Tohoku University Hospital, Sendai, Japan, ¹²Tohoku University Hospital, Sendai, Japan, ¹³Sasebo City General Hospital, Sasebo, Nagasaki, Japan

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: DMARDs, joint destruction, radiography and rheumatoid arthritis (RA)

Session Information

Title: Rheumatoid Arthritis - Clinical Aspects I: Drug Studies/Drug Safety/Drug Utilization/Disease Activity & Remission

Session Type: Abstract Submissions (ACR)

Background/Purpose: There has been few epidemiological report of longitudinal radiographic progression in rheumatoid arthritis (RA) patients captured in daily practice. In 20 related-centers of the Nagasaki University and Tohoku University in Japan we are conducting a large-scale prospective study (Apple Survey) to investigate extent of radiographic progression. We have tried to assess the extent of rapid radiographic progression (RRP) in synthetic disease modifying anti-rheumatic drugs (DMARDs)-treated RA patients.

Methods: We have selected the RA patients treated not by biologic DMARDs but by synthetic DMARDs for 1 year. One hundred fifty-three out of the 964 patients registered between May 09 and March 12 had evaluable data at present. Patients gave their informed consent to be subjected to the protocol that was approved by the Institutional Review Board of Nagasaki University, Tohoku University and related centers. DAS28-ESR was assessed every 3 months. Radiographs of the hands and feet were taken every 6 months. The images were scored by trained readers through modified total Sharp score (mTSS). RRP was defined as yearly progression of mTSS >3.0. We have examined what variables are associated with the development of RRP at 1 year.

Results: Ten variables including gender, disease duration at baseline, age, CRP at baseline (mg/dl), presence of autoantibodies (RF or anti-CCP Abs), DAS28-ESR at baseline, time-integrated DAS28-ESR during 1 year, mTSS at baseline, HAQ at baseline and the use of MTX or non-MTX DMARDs were evaluated through univariate and logistic regression analysis to explore the development of RRP at 1 year. RRP was found in 17 out of 153 patients (11.1%). Logistic regression analysis has found that short disease duration (p = 0.0061), younger age ( p = 0.038), high time-integrated DAS28-ESR ( p = 0.015) and high mTSS at baseline ( p = 0.035) are independent variables to predict the development of RRP. There were the trend of presence of autoantibodies ( p = 0.074) and non-MTX DMARDs use ( p = 0.054) toward RRP at 1 year.

Conclusion: Our results have revealed the characteristic of synthetic DMARDs-treated Japanese RA patients who develop RRP. The treat-to-target strategy is particularly recommended in these patients.

Disclosure:

A. Okada,
None;

A. Kawakami,
None;

T. Fukuda,
None;

T. Hidaka,
None;

T. Ishii,
None;

Y. Ueki,
None;

T. Kodera,
None;

M. Nakashima,
None;

Y. Takahashi,
None;

S. Honda,
None;

Y. Horai,
None;

T. Koga,
None;

R. Watanabe,
None;

H. Okuno,
None;

K. Eguchi,
None.

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