RA Joint Damage Driven by Residual Swelling

In patients with rheumatoid arthritis (RA), radiographic progression with nonbiologic treatment is minimal only when those in 28-joint Disease Activity Score (DAS 28) remission have no persistent residual joint swelling. Progression is comparable to that in patients with disease in remission according to other disease activity indices.

Aletaha and Smolen pooled 1-year clinical data on 864 patients in methotrexate (MTX) monotherapy arms of recent trials. They identified patients who had attained persistent DAS 28 remission from month 6 through month 12 and assessed their radiographic progression in total Sharp/van der Heijde scores (SHS) from baseline to 12 months, comparing those with and those without residual joint swelling.

Of 114 patients who achieved DAS 28 remission, those without residual joint swelling had less radiographic progression over 1 year than those with residual joint swelling. The proportion of patients with a total SHS progression higher than 0.5/y was significantly lower among those without joint swelling. DAS 28 remitters without joint swelling showed progression comparable to that in the total group of remitters by the Simplified Disease Activity Index and the Clinical Disease Activity Index.

The authors noted that tumor necrosis factor inhibitors in combination with MTX have a considerable impact on radiographic progression.