FRI0162 Radiographic progression of weight-bearing joint damage in patients with rheumatoid arthritis during TNF-blocking therapies – long-term follow-up
Authors: I. Matsushita, H. Motomura, E. Seki, T. Kimura
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> We have demonstrated that TNF-blocking therapies are effective in inhibiting the radiographic progression in weight-bearing joints with pre-existing Larsen grade 0-II during short term follow-up<sup>1,2)</sup>. However, it is not clarified that the observed effect is persistent during long-term TNF-blocking therapies. <h3>Objectives</h3> The purpose of this study is to assess radiographic progression of weight-bearing joint damage in patients with rheumatoid arthritis during long-term TNF-blocking therapies. <h3>Methods</h3> Thirty nine consecutive patients (5 male, 34 women, mean age of 59.3 years old) were evaluated at baseline and after TNF-blocking therapy (infliximab or etanercept). We assessed the radiographic progression of 240 weight-bearing joints (65 hip joints, 53 knee joints, 69 ankle joints, 53 subtalar joints) at baseline and every year after TNF-blocking therapy. The structural damage in the weight-bearing joints was evaluated using the Larsen scoring method at baseline. Radiographic progression of joint damage was defined as appearance of new erosion and/or enlargement of erosion above 2mm and/or joint space narrowing above 2mm. Survival rate was analyzed using Kaplan-Meier method and the end point was defined as progression of joint damage. <h3>Results</h3> Average follow-up period was 4.5 years (rang, 2∼7 years). Analysis of hip and knee joints indicated that 7-year survival rate was 94.0% in baseline grade 0/I joints. Radiographic progression was limited to cases with poor clinical response at 1 and 2 years. On the other hand, there was slow but gradual progression of damage in hip and knee joints with Larsen grade II and 7-year survival rate was only 38.9%. All of the hip and knee joints with pre-existing damage of grade III/IV showed rapid progression at 1 year follow-up period even under good response. The radiographic progression of ankle and subtalar joint damage was not significantly related to pre-existing damage. Seven-year survival rates of all ankle and subtalar joints with baseline Larsen grade 0/I, II and III/IV were 89.1%, 64.3% and 70.1%, respectively. <h3>Conclusions</h3> TNF-blocking therapy was effective in preventing the progression of weight-bearing joint damage. However, in hip and knee joint, it was sometimes difficult to inhibit the progression when the baseline Larsen grade had been at II-IV. Therefore, it is essential to pay attention to the occurrence of early radiographic damage, in addition to the disease activity, to avoid possible progression of hip and knee joint destruction. <h3>References</h3> Seki E., Matsushita I, Sugiyama E, et al: Radiographic progression in weight-bearing joints of patients with rheumatoid arthritis after TNF-blocking therapies. Clin Rheumatol 2009;28(4):453-460 Matsushita I, Motomura H, Seki E, et al: Effects and limitations of TNF-blocking therapies on weight-bearing joints in patients with rheumatoid arthritis. Ann Rheum Dis 2010;69(Suppl3):102 <h3>Disclosure of Interest</h3> None Declared