Estimated Pre-diagnosis Radiological Progression: an important tool for studying the effects of early DMARD therapy in RA

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Ann Rheum Dis. 2004 Apr 19 [Epub ahead of print]

Estimated Pre-diagnosis Radiological Progression: an important tool for

studying the effects of early DMARD- therapy in rheumatoid arthritis.

Wick MC, Lindblad S, Weiss RJ, Klareskog L, Van Vollenhoven RF.

Rheumatology Unit, Department of Medicine at Karolinska Hospital,

Stockholm, Sweden.

OBJECTIVE: To determine if intra-patient comparisons between

pre-diagnosis and subsequent radiological progression could be used to

assess the effects of DMARDs in a RA-inception cohort. Patients and

METHODS: We analyzed 149 non- randomized newly diagnosed RA patients.

Four groups were chosen: 1) patients treated with methotrexate (MTX,

n=56), 2) sulfasalazine (SSZ, n=55), 3) and auranofin (AUR, n=19), and

4) a control-group of patients who changed therapy at least twice,

representing poor therapy-responders with persistent clinical activity

(control, n=19). Radiographs were quantified using Larsen erosion score.

Taking the first onset of RA- symptoms as the earliest starting date for

radiological damage, the pre-diagnosis rate of radiological progression

was calculated and compared to the observed progression rate during the

first year after diagnosis while under DMARD-therapy. RESULTS: The mean

disease duration in all patients from onset of symptoms until diagnosis

of RA and DMARD-institution was 6.7+/-4.0 months. The mean baseline

Larsen score was 13.2+/-9.3, resulting in a mean estimated pre-diagnosis

progression rate of 23.6+/-12.4 Larsen score units/year. In the control-

and AUR-group, radiological progression after diagnosis was similar to

the progression predicted by the pre-diagnosis progression rates. In the

patients for whom MTX or SSZ was the first-line therapy, a marked

reduction (71% and 73% respectively; p<0.001) in radiographic

progression was seen compared to pre- diagnosis progression.

CONCLUSIONS: Pre-diagnosis rates of radiological progression can be used

quantitatively to obtain important information on the potential efficacy

of DMARDs, and indicate that MTX and SSZ, but not AUR, significantly

retard radiographic damage in the first year after diagnosis.

PMID: 15096329

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