RESEARCH - Progression of radiographic joint damage in RA: independence of erosions and joint space narrowing

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Ann Rheum Dis. Published Online First: 28 October 2008.

doi:10.1136/ard.2008.094128

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Extended Report

Progression of radiographic joint damage in rheumatoid arthritis:

Independence of erosions and joint space narrowing

f S Smolen 1*, Désirée MFM van der Heijde 2, Aletaha 3,

Xu 4, Han 4, Baker 4 and E St.Clair 5

1 Division of Rheumatology, Department of Internal Medicine III,

Medical University of Vienna, Austria

2 Leiden University Medical Center, Netherlands

3 Medical University of Vienna, Austria

4 Centocor, United States

5 Duke University Medical School, United States

Abstract

Objective: To compare the progression of erosions and joint space

narrowing (JSN) in patients with early active RA using data obtained

in the Active-Controlled Study of Patients Receiving Infliximab for

the Treatment of Rheumatoid Arthritis of Early Onset (ASPIRE).

Methods: This was a post hoc analysis of patients in ASPIRE who

received placebo plus methotrexate (MTX) or infliximab (3 or 6 mg/kg)

plus MTX. Radiographs of the hands (870 patients) and feet (871

patients) were obtained at baseline and week 54 and scored using the

van der Heijde/Sharp method. In total, 7,160 joints in the placebo

plus MTX group and 18,908 joints in the combined infliximab plus MTX

group were included in this analysis.

Results: At baseline 83.4% of joints in the placebo plus MTX group had

no radiographic damage, 8.5% had only erosions, 4.4% had only JSN, and

3.7% had both. The distribution was similar in the infliximab plus MTX

group. In the placebo plus MTX group, the majority of joints did not

have development or progression of radiographic damage from baseline

to week 54; among joints that did have development or progression of

damage at week 54, erosions occurred more often than JSN. The same

pattern was observed in the infliximab plus MTX group, although the

proportions of joints with damage at week 54 were generally larger in

the placebo plus MTX group.

Conclusions: Erosions were the predominant type of damage observed in

both treatment groups. There was a tendency for joints with existing

erosions or joint space narrowing to have progression of damage,

rather than development of new damage. Thus, erosions and joint space

narrowing are related but partly independent processes.

http://ard.bmj.com/cgi/content/abstract/ard.2008.094128v1?papetoc

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