Evaluation 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 (an interim report of Apple Survey)

Akitomo Okada¹, Atsushi Kawakami², Takaaki Fukuda³, Toshihiko Hidaka⁴, Tomonori Ishii⁵, Yukitaka Ueki⁶, Takao Kodera⁷, Munetoshi Nakashima¹, Yuichi Takahashi⁸, Seiyo Honda⁹, Yoshiro Horai², Tomohiro Koga¹⁰, Mami Tamai¹¹, Kiyoshi Aoyagi¹², Ryu Watanabe⁵, Hiroshi Okuno¹³ and Katsumi Eguchi¹⁴, ¹Japanese Red Cross Nagasaki Genbaku Hospital, 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, ⁸Yu Family Clinic, Sendai, Japan, ⁹Kurume University School of Medicene, Kurume, Japan, ¹⁰Departments of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan, ¹¹Center for Health & Community Medicine, Nagasaki University, Nagasaki, Japan, ¹²Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan, ¹³Tohoku University Hospital, Sendai, Japan, ¹⁴Sasebo City General Hospital, Sasebo, Nagasaki, Japan

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: prognostic factors, radiography and rheumatoid arthritis (RA)

Session Information

Title: Rheumatoid Arthritis - Clinical Aspects II: Predictors of Disease Course in Rheumatoid Arthritis - Treatment Approaches

Session Type: Abstract Submissions (ACR)

Background/Purpose: Disease modifying anti-rheumatic drugs (DMARDs) are known to inhibit radiographic progression in patients with rheumatoid arthritis (RA). However, there has been few epidemiological report of longitudinal radiographic progression in RA patients captured in daily practice. In 26 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 DMARDs-treated RA patients.

Methods: Nine hundred forty-two patients with RA, treated not by biologic DMARDs but by synthetic DMARDs at entry, were registered between May 09 and March 12 in this study. We have selected 742 RA patients having DAS28-ESR at entry >3.2 or apparent radiographic bone erosion and followed at least 1 year. Regarding to the RA patients treated by synthetic DMARDs without biologic DMARDs for 1 year, two hundred sixty-one patients 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: RRP was found in 31 out of 261 patients (11.9%). Eleven variables including gender, age, disease duration at baseline, DAS28-ESR at baseline, time-integrated DAS28-ESR during 1 year, CRP at baseline (mg/dl), presence of autoantibodies (RF or ACPA), the use of MTX or non-MTX DMARDs, the use of prednisolone, HAQ at baseline, mTSS at baseline were evaluated to explore the development of RRP at 1 year. Logistic regression analysis has found that short disease duration (p = 0.013, 2 year decrease), high time-integrated DAS28-ESR (p = 0.027, 10 increase) and high mTSS at baseline (p = 0.010, 5 increase) are independent variables to predict the development of RRP. There was the trend of non-MTX DMARDs use (p = 0.071) toward RRP at 1 year.

Conclusion: Considering the development of RRP, mTSS at baseline is high and the progression of joint destruction may occur at the early-stage of RA in case of treatment without MTX. Since not high DAS28-ESR at baseline but high time-integrated DAS28-ESR is also an independent predictor toward RRP, tight disease control by treat-to-target strategy is needed in daily clinical practice.

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;

M. Tamai,
None;

K. Aoyagi,
None;

R. Watanabe,
None;

H. Okuno,
None;

K. Eguchi,

UCB Pharma.,

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