AB0204 Radiographic progression of large joint damage in patients with rheumatoid arthritis treated with biological disease-modifying antirheumatic drugs (BDMARDS) and its predictive factors: results of 3 to 4 years follow-up
Authors: A. Nakajima, K. Terayama, M. Sonobe, H. Takahashi, Y. Akatsu, S. Taniguchi, M. Yamada, K. Nakagawa
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Although damage to large joints such as the shoulder, elbow, hip, knee, and ankle has a substantially larger impact on functional ability than damage to the small joints of the hand and foot,<sup>1 2</sup> large joints are not routinely monitored for progressive damage in patients with rheumatoid arthritis (RA). Furthermore, a little information is available regarding long-term follow-up results of radiographic progression of damage (RPD) to the large joints during treatment with biological disease-modifying antirheumatic drugs (bDMARDs). <h3>Objectives</h3> We investigated ratios of RPD to the large joints in RA patients treated with bDMARDs for 3 to 4 years and analysed association between RPD and patient backgrounds or Larsen grades of individual large joint. <h3>Methods</h3> Sixty-eight patients (naïve: 42, switch: 26) receiving bDMARDs (IFX: 5, ETN: 9, ADA: 7, GLM: 3, CZP: 5, TCZ: 28, ABT: 11) for 3 to 4 years or achieving bDMARDs-free status were included in this study. The mean age and disease duration at the start of bDMARDs was 62.7 year-old and 10.7 years, respectively, and baseline DAS28-ESR and HAQ was 4.61 and 1.014, respectively. A total of 311 joints including shoulder, elbow, hip, knee, and ankle were evaluated whether there was RPD during the observation period by comparing radiographs before and after the treatment. <h3>Results</h3> RPD was found in 22 patients (31.4%) and 32 joints (10.0%), and it occurred during the former half period in 17 joints and during the latter half period in 15 joints. Joints with Larsen grade (LG) III or more had significantly higher ratios of RPD than those with LG II or less (p&lt;0.01). An ROC analysis was performed to calculate the cut-off value for the progressive damage, which was 2.5 (sensitivity: 50.0%, specificity: 79.6%), suggesting that exceeding LG III would be a risk factor for the RPD to the large joints. A multivariate logistic regression analysis revealed that stage and baseline HAQ were independent risk factors for RPD (cut-off value: 2.5, odds ratio: 8.864 for stage; cut-off value: 1.4375, odds ratio: 6.316 for baseline HAQ). <h3>Conclusions</h3> The stage and baseline HAQ were associated with RPD to the large joints, and progressive damage is expected to increase when the stage exceeds III and/or functional disability exceeds an HAQ score of 1.5. Progressive damage also increases when LG exceeds III. Treatment with bDMARDs should be started before stage, HAQ, and LG exceed III, 1.5, and III, respectively. <h3>References</h3> [1] Drossaers-Bakker KW, Kroon HM, Zwinderman AH, Breedveld FC, Hazes JM. Radiographic damage of large joints in long-term rheumatoid arthritis and its relation to function. Rheumatology (Oxford)2000;39:998–1003. [2] Kuper HH, van Leeuwen MA, van Riel PL, Prevoo ML, Houtman PM, Lolkema WF, van Rijswijk MH. Radiographic damage in large joints in early rheumatoid arthritis: relationship with radiographic damage in hands and feet, disease activity, and physical disability. Br J Rheumatol1997;36:855–60. <h3>Disclosure of Interest</h3> None declared