Background/Purpose:

Retrospective studies have promoted the idea that RA has become a milder disease over the past decades[i]^{, [ii]}. These findings are questionable because of the impact of changing treatment strategies and DMARD use in these studies.

In one rheumatologic center in Germany the strategy to treat all newly diagnosed RA patients (pts) with either MTX or parenteral gold (gold) was established already in the 1970ies and kept constant for more than 20 years. In case of inefficacy or intolerability one treatment was usually replaced by the other. MTX and gold have been shown to be almost equally effective on disease activity and radiographic progression (RP) in early RA[iii]. This provided the unique opportunity to test the hypothesis of a secular trend to milder disease course in almost uniformly treated cohorts from three different decades.

Methods:

All pts first presenting in the center in the years 1978-1980, 1990 and 2000 with early (< 3 yr) physician confirmed RA were followed radiographically in regular intervals. ESR and RF status were available. Hand and feet radiographs from baseline and 1 and 3 years follow up were read with the Ratingen Score (RS) (range 0-190). Multiple regression analysis (MRA) was performed with age, gender, belonging to one of the three cohorts, disease duration, RF status, baseline radiographic score and the first DMARD as possible influencing factors on RP.

Results:

Baseline demographics, disease characteristics, mean RS and mean annual RP in 1^styear of the three cohorts are given in Table 1. 

Table 1

The results of the MRA are displayed in Table 2

Table 2

After MRA the increase of the RS did not differ between the cohorts (p=0.5496) with the RS at baseline (p <0.0001) and RF status (p = 0.0198) being the only parameters that showed a significant impact on radiographic progression.

Conclusion:

As almost all pts were treated with either one of two equally effective agents irrespective from the date of their first presentation, one may assume that RP was equally influenced by DMARD therapy in all three cohorts. A shift towards milder disease course over two decades would have led to less progression in the later cohorts compared to the early 1978-80 cohort. In contrast we found RP to be almost constant over time. The much better performance of many pts with early RA in recent years compared to the past is therefore most probably explained by more and better treatment options now available to most pts and that the concept of treat to target in early RA that has become widely accepted by rheumatologist.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/radiographic-progression-in-patients-with-early-rheumatoid-arthritis-has-not-become-milder-over-the-past-decades/