RESEARCH - RA joint progression in sustained remission is determined by disease activity levels preceding the period of radiographic assessment

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Arthritis Rheum. 2009 Apr 29;60(5):1242-1249.

Rheumatoid arthritis joint progression in sustained remission is

determined by disease activity levels preceding the period of

radiographic assessment.

Aletaha D, Funovits J, Breedveld FC, Sharp J, Segurado O, Smolen JS.

Medical University of Vienna, Vienna, Austria.

OBJECTIVE: Joint damage is related to disease activity in rheumatoid

arthritis (RA), but the degree of its progression and the temporal

associations between disease activity and joint damage are unclear.

The aim of this study was to evaluate whether there is a latency in

the effect of disease activity on radiographic progression in patients

with RA.

METHODS: Data were obtained from the

PREMIER trial, a 2-year randomized, controlled clinical trial of

adalimumab plus methotrexate versus methotrexate alone or adalimumab

alone in early RA. Radiographic progression of joint damage was

calculated using the modified total Sharp score in a subset of

patients whose disease was in remission (Simplified Disease Activity

Index </=3.3) in the second year of the trial. The progression of

damage in the second year was compared between groups of patients

whose disease was already in remission for an additional period of 3,

6, or 9 months during the first year. Analysis of variance was used to

test for a linear trend.

RESULTS: Among 794 patients with early RA, 119 (15%) achieved

sustained remission during the second year, with no difference in

radiographic progression across the 3 treatment groups. Radiographic

progression in the second year was significantly different between

patients with 3, 6, or 9 additional months of remission during year 1

(mean change in the modified Sharp score 1.19 in those with 3

additional months of remission versus 0.20 in those with 6 additional

months of remission and -0.32 in those with 9 additional months of

remission; P < 0.05). The results were supported by similar findings

in a series of sensitivity analyses.

CONCLUSION: These data indicate that the level of disease activity as

well as the duration of remission affect subsequent progression of

radiographic damage in RA. This latency between disease activity and

its effects on radiographic progression should be considered when

evaluating radiographic outcomes in trials of RA.

PMID: 19404938

http://www.ncbi.nlm.nih.gov/pubmed/19404938

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