Patient retention and radiograph progression of RA during a 3-year prospective study that prohibited DMARDs

[Guest guest]

J Rheumatol. 2004 Mar;31(3):470-81.

Patient retention and hand-wrist radiograph progression of rheumatoid

arthritis during a 3-year prospective study that prohibited disease

modifying antirheumatic drugs.

us HE, Di Primeo D, Sharp JT, Genant HK, Weissman BN, Weisman MH,

Sanda M.

Division of Rheumatology, UCLA Medical Center, Los Angeles, California,

USA.

OBJECTIVE: To quantitate patient retention and radiographic progression

rates in serial hand/wrist radiographs of patients with rheumatoid

arthritis (RA) who were not being treated with disease modifying

antirheumatic drugs (DMARD). METHODS: A total of 1433 RA patients with

1-7 years' disease duration entered a 3-year prospective randomized

double-blind clinical trial comparing the nonsteroidal antiiflammatory

drugs (NSAID) etodolac (300 or 1000 mg daily) and ibuprofen (2400 mg

daily). Standardized hand/wrist radiographs were obtained yearly and at

dropout if > 6 months after entry. DMARD were not permitted. Joint

erosion, joint space narrowing (JSN), and total scores of 3 readers were

averaged. RESULTS: At entry, mean duration of RA was 3.5 years (range

1-7); ages were 21-78 years; patients were 71% female, 84% Caucasian,

67% rheumatoid factor (RF) positive; tender joint count was 29, swollen

joint count 22, Westergren erythrocyte sedimentation rate (ESR) 49, and

C-reactive protein (CRP) 2.44. There were 824 (57.5%) patients who

completed >/= 6 months and had paired radiographs; 46% completed 48

weeks; 31%, 98 weeks; and 19%, 147 weeks. Months between paired

radiographs (time in study) averaged 23.1 (range 6-36). Mean progression

rates for total, erosion, and JSN scores (5.08, 2.53, and 2.54 units per

year, respectively) were significantly associated with time in study,

baseline RF, ESR, CRP, swollen joint count, presence of erosions at

entry, and with 20% and 50% composite clinical responses. Painful joint

count and RA duration were weakly associated only with progression of

erosions. Progression rates were not associated with age, sex,

corticosteroid use, or prior DMARD use. Patients who completed the

3-year trial had less severe disease activity and radiographic

progression than those who dropped out.

CONCLUSION: In this 3-year prospective double-blind clinical trial that

prohibited DMARD, retention rates (57.5%, 46%, 31%, and 19% at 0.5, 1,

2, and 3 years) were similar to those in the non-DMARD-treated placebo

groups of recent published studies. Radiographic progression rates are

reported for 824 non-DMARD-treated patients during RA of 1-10 years'

duration. This information may be useful as background information in

the interpretation of longterm clinical trials that evaluate joint

radiographic outcomes.

PMID: 14994390

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org