RESEARCH - Repair of erosions occurs almost exclusively in damaged joints without swelling

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Ann Rheum Dis. Published Online First: 21 October 2009.

doi:10.1136/ard.2009.119156

Repair of erosions occurs almost exclusively in damaged joints without swelling

Cédric Lukas1,*, Désirée van der Heijde2, Saeed Fatenejad3, Landewé4

1 Lapeyronie Hospital Montpellier, France;

2 Leiden University Medical Center, Netherlands;

3 Wyeth Research, United States;

4 University of Maastricht, Netherlands

ABSTRACT

Objective: Negative radiographic change scores obtained under blinded

time-sequence conditions suggest that repair of joints may indeed

occur. It is likely that - C if it truly exists - C repair would be

preferentially seen in clinically inactive joints from patients

treated with drugs with well known structural efficacy.

Patients and methods: Radiographs from patients of the TEMPO trial

were scored twice by two readers according to the Sharp/van der Heijde

score, blinded to both treatment and true time sequence. Single-joint

change scores in erosions were coupled with single joint swelling

scores obtained from clinical examination. Consistency of observed

improvement across readers and repeat reads was described, and factors

expected to increase the likelihood of occurrence of both worsening

and improvement of erosion were tested by GEE modelling.

Results: In every of the 4 independent reads, the mean change in

erosion score was statistically significantly negative only in the

subgroup of joints with absent or improved swelling, when erosions

were present at baseline. Multivariate analysis showed that worsening

of erosion score in a joint was significantly increased if that joint

was already damaged at study entry, clinical swelling persisted, and

methotrexate was used instead of etanercept. Repair was associated

with improvement of swelling and use of etanercept (p0.007 for all

associations).

Conclusion: Repair of erosions almost exclusively occurs in joints

with improvement or absence of swelling, in patients treated with

etanercept. Progression is seen more frequently in joints with

persistent swelling, in patients receiving methotrexate monotherapy,

primarily if damage is already present.

http://ard.bmj.com/cgi/content/abstract/ard.2009.119156v1?papetoc

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