RESEARCH - Radiological damage in patients with RA in sustained remission

[Guest guest]

Published Online First: 25 August 2006. doi:10.1136/ard.2006.057497

ls of the Rheumatic Diseases 2007;66:358-363

--------------------------------------------------------------------------------

EXTENDED REPORT

Radiological damage in patients with rheumatoid arthritis on sustained remission

G Cohen 1, L Gossec 2, M Dougados 2, A Cantagrel 3, P Goupille 4, JP

Daures 5, N Rincheval 5, B Combe 1

1 Immuno-Rhumatologie, Montpellier I University, Centre Hospitalier

Universitaire Lapeyronie, Montpellier, France

2 Department of Rheumatology B, Paris 5 University, Cochin Hospital,

Paris, France

3 Service de Rhumatologie, Centre Hospitalier Universitaire Rangueil,

Toulouse, France

4 Service de Rhumatologie, Centre Hospitalier Universitaire Tours, Tours, France

5 Laboratoire Biostatistique et Epidémiologie, Institut Universitaire

de Recherche Clinique, Montpellier, France

Objective: To assess the radiological damage progression in patients

with recent rheumatoid arthritis in sustained remission.

Methods: A cohort of 191 patients with active early (<1 year)

rheumatoid arthritis was prospectively assessed at baseline, 3 and 5

years by the Disease Activity Score (DAS) and the Sharp–van der Heijde

Score (SHS) for radiographic damage. Patients in remission (DAS<1.6)

at the 3-year and 5-year time points were compared with patients with

a persistently active rheumatoid arthritis by Wilcoxon's signed rank

test.

Results: 57 patients died, were lost to follow-up or had incomplete

data; 30 (15.7% of those who completed) patients were in remission at

3 and 5 years. The SHS in these two groups was not significantly

different at baseline (p = 0.15), but was lower in the remission group

at 5 years (p = 0.0047). The median (IQR) radiographic score increased

from 0.5 (0–7) at baseline to 2.5 (0–14) after 5 years for the

remission group (p = 0.18) and from 2 (0–7) to 13 (3–29) in the group

with active rheumatoid arthritis (p<0.001). 5 (16.7%) patients in

remission had relevant progression of radiographic damage (ie,

progression >4.1 points) and 6 (20%) presented new erosions in a

previously unaffected joint between the third and the fifth years.

Conclusion: Patients with early rheumatoid arthritis in sustained

remission did not present statistically significant radiographic

degradation at the group level; nevertheless, 16.7% of these patients

did present degradation. Absence of progression should be part of the

remission definition in rheumatoid arthritis.

http://ard.bmj.com/cgi/content/abstract/66/3/358

Not an MD