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

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Published Online First: 28 October 2008. doi:10.1136/ard.2008.094128

ls of the Rheumatic Diseases 2009;68:1535-1540

Extended report

Progression of radiographic joint damage in rheumatoid arthritis:

independence of erosions and joint space narrowing

J S Smolen1,2, D M van der Heijde3, D Aletaha1, S Xu4, J Han4, D

Baker4, E W St Clair5

1 Division of Rheumatology, Department of Internal Medicine III,

Medical University of Vienna, Vienna, Austria

2 Second Department of Medicine, Center for Rheumatic Diseases,

Hietzing Hospital, Vienna, Austria

3 Leiden University Medical Center, Leiden, The Netherlands

4 Centocor Incorporated, Malvern, Pennsylvania, USA

5 Duke University Medical Center, Durham, North Carolina, USA

Objective: To compare the progression of erosions and joint space

narrowing (JSN) in patients with early active rheumatoid arthritis

(RA) using data obtained in the " Active-controlled Study of Patients

receiving Infliximab for the treatment of Rheumatoid arthritis of

Early onset " (ASPIRE) study.

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, 7160 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. There was a tendency

for joints with existing erosions or JSN to have progression of

damage, rather than development of new damage.

Conclusions: Erosions were the predominant type of damage observed in

both treatment groups. Erosions and JSN are related but partly

independent processes.

http://ard.bmj.com/cgi/content/abstract/68/10/1535?etoc

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