Rapid Radiographic Progression Research Articles

Predictive value of autoantibodies from anti-CCP2, anti-MCV and anti-human citrullinated fibrinogen tests, in early rheumatoid arthritis patients with rapid radiographic progression at 1 year: results from the ESPOIR cohort

ObjectivesWe compared the ability of antibodies against cyclic citrullinated peptides (anti-CCP2), against mutated citrullinated vimentin (anti-MCV) and against citrullinated fibrinogen (AhFibA) to predict 1 year rapid radiographic progression (RRP; total...

Osteoprotegerin and tumor necrosis factor-related apoptosis-inducing ligand as prognostic factors in rheumatoid arthritis: results from the ESPOIR cohort.

IntroductionWe previously reported that low ratio of osteoprotegerin (OPG) to tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) was associated with Disease Activity Score in 28 joints (DAS28) remission at 6 months in patients with early rheumatoid arthritis (RA). Here, we aimed to evaluate the value of baseline OPG/TRAIL ratio in predicting clinical and radiological outcomes in patients with early RA in the ESPOIR cohort.MethodsOPG and TRAIL serum concentrations were assessed in the ESPOIR cohort patients. Patients with definite RA were included in this study. Patients were excluded if they had high erosion score at baseline (>90th percentile) or received biological therapy during the first 2 years of follow-up. Data were analyzed by univariate analysis and multivariate logistic regression to predict 1-year DAS28 remission and 2-year radiographic disease progression.ResultsOn univariate analysis of 399 patients, OPG/TRAIL ratio at baseline was significantly lower in patients with than without remission at 1 year (p = 0.015). On multivariate logistic regression including age, gender, body mass index and DAS28, low OPG/TRAIL ratio was independently associated with remission at 1 year (odds ratio 1.68 [95 % confidence interval 1.01–2.79]). On univariate analysis, high OPG/TRAIL ratio at baseline was associated with rapid progression of erosion at 2 years (p = 0.041), and on multivariate logistic regression including age, anti-citrullinated protein antibody positivity and C-reactive protein level, OPG/TRAIL ratio independently predicted rapid progression of erosion at 2 years.ConclusionsOPG/TRAIL ratio at baseline was an independent predictor of 1-year remission and 2-year rapid progression of erosion for patients with early rheumatoid arthritis. Thus, OPG/TRAIL ratio could be included in matrix prediction scores to predict rapid radiographic progression. Further confirmation in an independent cohort is warranted.

SAT0039 Development and Validation of A Prognostic Clinical Model for RAPID Radiographic Progression in Patients with RA

BackgroundIdentification of factors predictive of rapid radiographic progression (RRP) in RA pts will enable clinicians and policymakers to target appropriate treatment strategies to at-risk pts.ObjectivesTo evaluate baseline (BL) factors associated...

AB0258 Persistence of Extensive MRI Osteitis Associates RAPID Radiographic Progression with Predominant Loss of Joint SPACE Narrowing and Hand Grip in Patients with Rheumatoid Arthritis Inadequate Response to Methotrexate

BackgroundMagnetic resonance imaging (MRI) osteitis has been reported to be a strong independent predictor of radiographic joint damage (RJD) in rheumatoid arthritis (RA) (1). We reported continuation of MRI osteitis,...

SAT0046 Extensive MRI Osteitis is Associated with RAPID Radiographic Progression in Early but not Advanced Rheumatoid Arthritis

BackgroundPredictor for rapid radiographic progression (RRP) is still unknown. It has been reported that MRI osteitis is a strong independent predictor for radiographic joint damage (RJD) especially in early rheumatoid...

AB0219 Evaluation of the Japanese Patients with Rheumatoid Arthritis (RA) of RAPID Radiographic Progression (RRP) Treated with Synthetic Disease Modifying Anti-Rheumatic Drugs (DMARDS) in Daily Practice: A Large-Scale Prospective Longitudinal Cohort Study

BackgroundDisease modifying anti-rheumatic drugs (DMARDs) are known to inhibit radiographic progression in patients with rheumatoid arthritis (RA). However, there has been few epidemiological report of longitudinal radiographic progression in RA...

AB0278 Mri-Proven Osteitis at Baseline Predicts the Development of RAPID Radiographic Progression at 1 Year toward Patients with Early-Stage Rheumatoid Arthritis: Results from Nagasaki University Early Arthritis Cohort

BackgroundEULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis (RA) states that magnetic resonance imaging (MRI) bone oedema (osteitis) is a strong...

AB0274 The Influence of Continuous Remission Rate on Functional Disability and Radiographic Progression for Rheumatoid Arthritis in A Japanese Observational Cohort

BackgroundOne goal of clinical remission in rheumatoid arthritis (RA) is to halt joint damage. The continuous clinical remission in established RA may result in improved function and reduced radiographic progression.ObjectivesThe...

FRI0233 Multireader Evaluation Could be an Alternative to Monoreader Evaluation and Improve Feasibility to Detect Radiographic Progression in Large Longitudinal Cohort of Rheumatoid Arthritis Patients (ESPOIR)

BackgroundStructural progression in rheumatoid arthritis (RA) is a major outcome. Radiographic scoring should be performed by one or two readers, blinded to clinical data. This method may be limited in...

Clinical, Functional, and Radiographic Implications of Time to Treatment Response in Patients With Early Rheumatoid Arthritis: a Posthoc Analysis of the PREMIER Study

Rheumatoid arthritis (RA) treatment recommendations suggest target attainment within the first 3 months of therapy, yet delayed clinical responses can occur. This analysis assessed the longterm clinical, functional, and radiographic outcomes associated with delayed responses to methotrexate (MTX) monotherapy or to the combination of adalimumab (ADA) + MTX. In this posthoc analysis, patients with early RA who received MTX monotherapy or ADA + MTX in the PREMIER study were categorized based on clinical responses at 3 and 6 months [American College of Rheumatology response, 28-joint Disease Activity Score (DAS28)-C-reactive protein (CRP) improvement and targets]. "Month 3" responders met the clinical measure at both months 3 and 6, and "Month 6" responders met the clinical measure only at Month 6. The odds of achieving longterm outcomes [remission (DAS28-CRP < 2.6), normal function (Health Assessment Questionnaire-Disability Index < 0.5), or rapid radiographic progression (Δ modified total Sharp score > 3 U/yr)] were modeled using logistic regression, including treatment, response, and interaction. A delayed or low-level response was associated with poorer longterm outcomes. Generally, MTX Month 6 responders demonstrated worse clinical, functional, and radiographic outcomes than Month 3 MTX and Month 3 or 6 ADA + MTX responders. Although similar longterm benefit was observed for ADA + MTX responders, delayed (Month 6) responders exhibited downward trends in clinical, functional, and radiographic outcomes that were comparable with those experienced by Month 3 MTX responders. Response speed and magnitude predict longterm outcomes in patients with early RA treated with MTX or ADA + MTX. MTX-treated patients failing to demonstrate a Month 3 clinical response have less-favorable outcomes than other groups, while outcomes in ADA + MTX Month 3 and Month 6 responders tended to be comparable.

Two-year clinical and radiologic follow-up of early RA patients treated with initial step up monotherapy or initial step down therapy with glucocorticoids, followed by a tight control approach: lessons from a cohort study in daily practice

The objective of the study was to evaluate the effect of initial disease-modifying antirheumatic drug (DMARD) combination therapy with steroids (ICTS) and DMARD monotherapy (IMT) on the clinical and radiologic evolution of patients with early rheumatoid arthritis (RA) over a 2-year treatment period, applying tight control (TC) in daily practice. Seventy-four DMARD-naive early RA patients received ICTS or IMT in a TC setting. Baseline and year 1 and year 2 X-rays of hands and feet were scored according to Sharp/van der Heijde. Rapid radiographic progression (RRP) was defined as total Sharp score (TSS) of >5 units/year. At year 1, both treatment groups achieved 50 % remission. At year 2, 37 % of IMT and 60 % of ICTS patients were in remission, despite ICTS patients having initially a more severe RA profile. RRP was found in 4/74 patients at year 1: 3 IMT and 1 ICTS patients. Remarkably, three of these four patients had no radiographic progression in the second year. Five other patients had RRP in the second year: four IMT and one ICTS patients. In a TC setting, ICTS and IMT can prevent radiographic progression in the majority of patients in the daily practice of a Belgian academic hospital over 2 years. ICTS seems to be more effective than IMT in achieving higher remission rates and less radiographic progression.

LDL Cholesterolemia as a Novel Risk Factor for Radiographic Progression of Rheumatoid Arthritis: A Single-Center Prospective Study

Dyslipidemia has been implicated in various musculoskeletal diseases, including rheumatoid arthritis (RA). Evidence is emerging that there might be a pathogenic interaction among inflammation, dyslipidemia, and adipokines. We prospectively investigated the association of cumulative lipid levels with radiographic progression of RA. RA patients (n = 242) underwent plasma cholesterol assessment at four visits. Disease activity parameters and X-rays of the hands and feet were also serially monitored in these patients. The cumulative inflammatory burden and lipid levels were estimated by time-integrated values. Serum leptin and adiponectin concentrations were determined by ELISA. When patients were divided into three groups according to time-integrated lipid levels, as expected, patients with LDL cholesterol and/or triglyceride levels in the third tertile had persistently higher ESR and CRP levels. In parallel, a more rapid radiographic progression over two years was observed in patients with higher LDL cholesterol and/or triglyceride levels. In multivariate analysis, time-integrated LDL cholesterol was independently associated with radiographic progression. Particularly, the risk of radiographic progression was 5.6-fold in a subgroup with both LDL cholesterol and triglyceride levels in the third tertile. Moreover, LDL cholesterol synergistically increased the adjusted probability of radiographic progression in patients with high serum leptin levels but not in those without. These results demonstrate that LDL cholesterolemia is a novel serum marker that can be used to predict radiographic progression of RA, which seems to be related to circulatory leptin levels. We suggest that personalized and more aggressive anti-rheumatic therapy is required for dyslipidemic subgroups in RA patients.

FRI0437 How to identify patients at high risk for rapid radiographic spinal progression early in the course of axial spondyloarthritis?

BackgroundIdentification of patients with axial spondyloarthritis (axSpA) who are at high risk for rapid radiographic progression is of high relevance, because these patients might require an active treatment and they...

FRI0067 Prognostic factors for rapid radiographic progression are different between tnf and non-tnf inhibitor

BackgroundThe cause of the Rapid Radiographic Progression (RRP) is still unclear, and RRP is resistant to any biological treatment. Many prognostic factors including clinical and serologic marker, ultrasound and MRI...

THU0121 Characteristic of the Japanese Patients with Rheumatoid Arthritis (RA) of Rapid Radiographic Progression (RRP) Treated with Synthetic Disease Modifying Anti-Rheumatic Drugs (DMARDS) in Daily Practice: A Large-Scale Prospective Longitudinal Cohort Study

BackgroundIt is well known that disease modifying anti-rheumatic drugs (DMARDs) inhibit radiographic progression in patients with rheumatoid arthritis (RA), however, there has been few epidemiological report of longitudinal radiographic progression...

THU0144 Two Year Radiological Follow-Up of Early Rheumatoid Arthritis Patients Treated with Initial Step Up Monotherapy or Initial Step Down Therapy with Glucocorticoids, Followed by a Tight Control Approach

BackgroundCombination therapy with disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids(GCs) or biological agents is superior in achieving clinical response and preventing joint damage compared to DMARD monotherapy in patients with early...

FRI0213 Changes in anti-ccp antibody (ACPA) due to tocilizumab (TCZ) treatment and predicting rapid radiographic progression (RRP) in patients with rheumatoid arthritis (RA):actor study

BackgroundACPA has been reported to exacerbate inflammation, activate osteoclasts, and stimulate bone resorption1). At least thus far ACPA has been no more than a diagnostic marker, and its potential for...

THU0109 Treating to target ultrasound with clinical remission better effects than clinical remission in RRP

BackgroundTreatment of rheumatoid arthritis (RA) should aim at full remission. However,recent publications described rapid radiographic progression (RRP) existed despite initial biologics and methotrexate combination therapy in early RA. In RRP,...

THU0211 Combination of Intra-Articular Steroid Injection and Etanercept More Effective Than Etanercept in Rapid Radiographic Progression Patients with Rheumatoid Arthritis: A Randomized, Open Label, X Ray Reader Blinded Study

BackgroundTreatment of rheumatoid arthritis (RA) should aim at full remission. However, recent publications described rapid radiographic progression (RRP) existed despite initial biologics and methotrexate combination therapy in early RA. In...

FRI0084 The presence of magnetic resonance imaging-proven osteitis at entry predicts the development of rapid radiographic progression in patients with early rheumatoid arthritis

BackgroundMagnetic resonance imaging (MRI) is known as high sensitive imaging modality toward the patients with rheumatoid arthritis (RA). We have reported an importance of MRI-proven symmetrical synovitis, osteitis and bone...