Relationship between disease activity and radiologic progression in patients with RA: A longitudinal analysis.

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Arthritis Rheum. 2004 Jul;50(7):2082-93.

The relationship between disease activity and radiologic progression in

patients with rheumatoid arthritis: A longitudinal analysis.

Welsing PM, Landewe RB, Van Riel PL, Boers M, Van Gestel AM, Van Der

Linden S, Swinkels HL, Van Der Heijde DM.

University Medical Center Nijmegen, Nijmegen, The Netherlands.

OBJECTIVE: Radiologic progression in rheumatoid arthritis (RA) is

considered the consequence of persistent inflammatory activity. To

determine whether a change in disease activity is related to a change in

radiologic progression in individual patients, we investigated the

longitudinal relationship between inflammatory disease activity and

subsequent radiologic progression. METHODS: The databases of the

University Medical Center Nijmegen (UMCN) cohort and the Maastricht

Combination Therapy in RA (COBRA) followup study cohort were analyzed.

The UMCN cohort included 185 patients with early RA who were followed up

for up to 9 years. Patients were assessed every 3 months for disease

activity and every 3 years for radiologic damage. The COBRA cohort

included 152 patients with early RA who were followed up for up to 6

years. Patients were assessed at least every year for disease activity

and every 12 months for radiologic damage. Disease activity was assessed

with the Disease Activity Score (DAS) (original DAS in the UMCN cohort,

DAS28 in the COBRA cohort). Radiologic damage was measured by the

Sharp/van der Heijde score in both cohorts. Data were analyzed with

longitudinal regression analysis (generalized estimating equations

[GEE]), using autoregression for longitudinal associations and

radiologic damage as the dependent variable. Time, time(2) baseline

predictors for radiologic progression and their interactions with time,

as well as DAS/DAS28 (actual values or interval means and interval SDs

of the means) were subsequently modeled as explanatory variables.

RESULTS: Data analyzed by GEE showed a decrease in radiologic

progression over time (regression coefficient for time(2) -1.0 [95%

confidence interval -1.4, -0.6] in the UMCN cohort and -0.4 [95%

confidence interval -0.8, 0.0] in the COBRA cohort). After adjustment

for time effects and baseline predictors of radiologic progression and

their interactions with time, a positive longitudinal relationship was

indicated by autoregressive GEE between the mean interval DAS and

radiologic progression in the UMCN cohort (regression coefficient 5.4

[95% confidence interval 2.1, 8.6]), and between the DAS28 and

radiologic progression in the COBRA cohort (regression coefficient 1.4

[95% confidence interval 0.8, 2.0]). In the UMCN cohort, the SD of the

mean interval DAS was independently longitudinally related to the

radiologic progression over the same periods (regression coefficient

20.2 [95% confidence interval 7.2, 33.3]). In both cohorts, the

longitudinal relationships between (fluctuations in) disease activity

and radiologic progression were found selectively in rheumatoid factor

(RF)-positive patients.

CONCLUSION: Radiologic progression is not linear in individual patients.

Fluctuations in disease activity are directly related to changes in

radiologic progression, which supports the hypothesis that disease

activity causes radiologic damage. This relationship might only exist in

RF-positive patients.

PMID: 15248205

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