Association Between Baseline Radiographic Damage and Improvement in Physical Function After Treatment of Patients with RA

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Ann Rheum Dis. 2004 Jul 29 [Epub ahead of print]

Association Between Baseline Radiographic Damage and Improvement in

Physical Function After Treatment of Patients with Rheumatoid Arthritis.

Breedveld FC, Han C, Bala M, Baker D, Kavanaugh AF, Maini RN, Lipsky PE.

Leiden University Medical Center, Netherlands.

OBJECTIVES: The objectives of this study were to identify the factors

associated with poor physical function in patients with rheumatoid

arthritis (RA) and to assess whether baseline joint damage has an impact

on improvement in physical function after patients were treated with

infliximab plus methotrexate (MTX) or placebo plus MTX. METHODS: ATTRACT

(Anti-TNF Trial in RA with Concomitant Therapy) was a

placebo-controlled, randomized trial in which a total of 428 patients

with active RA despite MTX therapy received placebo (i.e., MTX alone) or

infliximab at 3 mg/kg or 10 mg/kg every 4 or 8 weeks along with MTX for

54 weeks. Clinical outcomes and physical function as measured by the

Health Assessment Questionnaire (HAQ) were collected from baseline

through week 54. Structural damage was assessed using the van der Heijde

modification of the Sharp score. The odds ratio (OR) for factors

associated with severe functional disability (HAQi(3)2.0) at baseline

were estimated using multiple logistic regression analyses, and baseline

factors related to the change in physical function after treatment at

week 54 were examined using multiple regression analyses. RESULTS:

Baseline radiographic scores were significantly associated with baseline

HAQ scores. After adjustment for demographic characteristics in the

logistic regression model, baseline disease activity scores,

radiological joint damage, fatigue, and morning stiffness were found to

be significantly associated with severe functional disability (HAQ>2.0),

with OR values of 2.00 (1.53-2.63), 1.82 (1.15-2.87), 1.19 (1.05-1.34),

and 1.07 (1.01-1.13), respectively. In the multiple linear regression

model, physical disability, joint damage, and fatigue at baseline were

significantly correlated with less improvement in physical function

after treatment. Furthermore, infliximab treatment was associated with

significantly greater improvement in physical function.

CONCLUSION: Greater joint damage at baseline was significantly

associated with both poorer physical function at baseline and less

improvement in physical function after treatment. These results

underscore the potential importance of early intervention to slow the

progression of joint destruction.

PMID: 15286005

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