RESEARCH - Clinical activity after 12 weeks of treatment with nonbiologics in early RA may predict articular destruction 2 years later

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Clinical Activity After 12 Weeks of Treatment with Nonbiologics in

Early Rheumatoid Arthritis May Predict Articular Destruction 2 Years

Later

YOICHI ICHIKAWA, TERUNOBU SAITO, HISASI YAMANAKA, MASASHI AKIZUKI,

HIROBUMI KONDO, SHIGETO KOBAYASHI, HISAJI OSHIMA, SHINICHI KAWAI,

NOBUAKI HAMA, HIDEHIRO YAMADA, TSUNEYO MIMORI, KOICHI AMANO, YASUSHI

TANAKA, YASUO MATSUOKA, SUMIKI YAMAMOTO, TSUKASA MATSUBARA, NORIKAZU

MURATA, TOMIAKI ASAI and YASUO SUZUKI, the Study Group for the

Japanese Ministry of Health, Labor and Welfare, Research for

Establishment of Therapeutic Guidelines in Early Rheumatoid Arthritis

Program

From the Department of Rheumatic, Collagen and Allergic Diseases, St.

nna University School of Medicine, Kawasaki; Institute of

Rheumatology, Tokyo Woman’s Medical University, Tokyo; Department of

Internal Medicine, Yokohama Municipal Citizen’s Hospital, Yokohama;

Department of Internal Medicine, Kitazato University School of

Medicine, Sagamihara; Department of Internal Medicine, Juntendo

University School of Medicine, Tokyo; Department of Internal Medicine,

Fujita Health University, Toyoake; Institute of Medical Science, St.

nna University School of Medicine, Kawasaki; Department of

Internal Medicine, School of Medicine, Keio University, Tokyo;

Department of Rheumatology and Clinical Immunology, Saitama Medical

Center, Kawagoe; Department of Internal Medicine, Konan Kakogawa

Hospital, Kakogawa; Department of Internal Medicine, Kawasaki

Municipal Hospital, Kawasaki; The Centre for Rheumatic Diseases,

Matsuyama Red Cross Hospital, Matsuyama; Department of Orthopedics,

Matsubara Mayflower Hospital, Kato; Department of Rheumatology,

National Hospital Organization, Osaka Minami Medical Center, Osaka;

and Department of Orthopedics, National Hospital Organization, Nagoya

Medical Center, Nagoya, Japan.

Abstract

Objective. To investigate earlier prediction of future articular

destruction in patients with early rheumatoid arthritis (RA).

Methods. We randomly allocated patients with RA with disease duration

< 2 years to different nonbiologic disease modifying antirheumatic

drug (DMARD) therapies in a double-blind trial. Progression of

articular destruction over the 96-week treatment period was assessed

using the modified Sharp method.

Results. Progression of articular destruction correlated more strongly

with the American College of Rheumatology (ACR) core set measures

after 12 weeks of treatment than with pretreatment values. Multiple

regression analysis of data after 12 weeks yielded a correlation

coefficient of 0.711. The sensitivity and specificity to predict

articular destruction over the 75th percentile of the cohort were

78.6% and 84.6%, respectively. Patients who showed articular

destruction over the 75th percentile of the cohort had low response to

treatment at 12 weeks, and continued to have high clinical disease

activity thereafter. Contrasting data were found in patients with slow

progression of articular destruction.

Conclusion. In patients with early RA, ACR core set measures after 12

weeks of nonbiologic DMARD treatment may predict articular destruction

2 years later. Low response to treatment at 12 weeks and continuing

high disease activity thereafter were found in patients with rapid

radiological progression. These data can be used to determine the

appropriateness of treatment at 12 weeks and aid the decision to

introduce biologic DMARD.

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http://jrheum.org/content/37/4/723.abstract

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