RESEARCH - Radiographic progression and remission rates in early RA: CIMESTRA

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Ann Rheum Dis. 2010 May 5. [Epub ahead of print]

Radiographic progression and remission rates in early rheumatoid

arthritis - MRI bone oedema and anti-CCP predicted radiographic

progression in the 5-year extension of the double-blind randomised

CIMESTRA trial.

Hetland ML, Stengaard-Pedersen K, Junker P, Ostergaard M, Ejbjerg BJ,

sen S, Lottenburger T, Hansen I, Tarp U, Andersen LS, Svendsen A,

Pedersen JK, Lauridsen UB, Ellingsen T, Lindegaard H, Pødenphant J,

Vestergaard A, Jurik AG, Hørslev-sen K; the CIMESTRA study group.

1Department of Rheumatology, Copenhagen University Hospital, Hvidovre

and Glostrup, Denmark.

Abstract

OBJECTIVE: At 5 years' follow-up of early (<6 months) rheumatoid

arthritis patients to (1) investigate whether initial combination

therapy with methotrexate (MTX) and ciclosporin (CSA) (n=80) is

superior to initial monotherapy with MTX (n=80) with respect to

prevention of radiographic progression, (2) investigate whether the

favourable clinical and radiographic response reported at 2 years in

the CIMESTRA trial can be maintained and (3) identify predictors of

radiographic outcome.

METHODS: 139 patients completed 5 years' follow-up with maintained

double-blinding and a strict synovitis suppressive treatment strategy

with intra-articular betamethasone injections (intra-articular

glucocorticosteroid (GC)) and escalation of disease-modifying

anti-rheumatic drug treatment. Disease activity, total Sharp-van der

Heijde Score (TSS) of hands, wrists and forefeet were assessed at

baseline and after 3, 4 and 5 years. MRI of the wrist and anti-cyclic

citrullinated peptide (anti-CCP) were assessed at baseline.

RESULTS: At 5 years, TSS progression rate was <1 unit/year and 47% had

not progressed radiographically since baseline. 78% were in Disease

Activity Score remission, 56% in American College of Rheumatology

remission and 17% withdrawn from treatment due to remission. There

were no differences between initial treatment groups. MRI-bone marrow

oedema, TSS and anti-CCP predicted radiographic progression at 5

years.

CONCLUSION: Early and strict synovitis suppressive treatment with MTX

and intra-articular GC lead to high remission rates and halting of

erosive progression at 5 years. No additional effect of initial

combination therapy with CSA was found. The results parallel those

reported for tumour necrosis factor alpha antagonists. Baseline

MRI-bone oedema, TSS and anti-CCP predicted radiographic progression.

PMID: 20444751

http://www.ncbi.nlm.nih.gov/pubmed/20444751

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