Radiologic Damage Predicts Long-term Outcomes in Severe RA

Baseline radiologic damage can predict long-term patient-related outcomes in patients with severe rheumatoid arthritis, according to a new study.  Several studies have shown the predictive value of radiologic damage assessment using patient-related outcomes in the course of rheumatoid arthritis, in particular associations of baseline radiologic joint damage and physical functioning, for up to a handful of years. German researchers studied a unique cohort of patients with very severe disease who started taking methotrexate between 1980 and 1987 in the early days of methotrexate therapy in rheumatology. They conducted a post-hoc analysis of data obtained in a prospective single-center observational trial of 271 rheumatoid arthritis patients.  At baseline, the patients had mean disease duration of 8.5 years. The disease was active with a mean number of swollen joints of 18 (out of 32) and a mean erythrocyte sedimentation rate of 55 mm/hour. Virtually all of the patients (95%) had radiologic damage.[[{"type":"media","view_mode":"media_crop","fid":"42842","attributes":{"alt":"@karelnoppe\\Shutterstock.com","class":"media-image media-image-right","id":"media_crop_3560920804738","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4661","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":" ","typeof":"foaf:Image"}}]] After 18 years, patient-related outcomes could be assessed in 78 (29%) of the patients in three dimensions, according to the International Classification of Functioning and Disability. These dimensions included the number of large joints with limited motion for the dimension “body functions and structure;” self-reported physical functioning for the dimension “activities at the individual level;” and, self-sufficiency for the dimension “participation in society.” The data show that the degree of radiologic damage at baseline was the only predictor of patient-related outcomes in all three dimensions. Measures of disease activity at baseline or disease duration at baseline had no impact on these patient-related outcomes after 18 years. “This finding clearly backs the concept that radiologic damage does not only mirror the clinical damage caused by the preceding inflammatory process but also predicts the future destructive tendency of the disease,” the authors wrote. A secondary analysis showed a strong association of baseline radiologic damage of hands and feet with the number of joints with limited range of motion, deformities or operations after 18 years. The authors noted that the impact of disease activity and joint destruction on physical functioning tends to change over the course of rheumatoid arthritis.  They pointed out that most of the patients had rather advanced disease at baseline. With modern treatment strategies, patients may never get to the late stage of the disease. The authors believe their results strengthen the importance of radiologic evaluation of joint damage at hands and feet for treat¬ment decisions in rheumatoid arthritis. 

References:

Krause D, Gabriel B, et al.

"Radiologic damage at baseline predicts patient-related outcomes 18 years after the initiation of methotrexate therapy in patients with severe rheumatoid arthritis,"

Clin Exp Rheumatol. 2015 Sep-Oct;33(5):611-6. Epub 2015 Aug 27.