Reductions in radiographic progression in early RA over 25-years: changing contribution from RF in 2 multi-centre UK inception cohorts

Carpenter, Lewis; Norton, Sam; Nikiphorou, Elena; Jayakumar, Keeranur; McWilliams, Daniel F.; Rennie, Kirsten L.; Dixey, Josh; Kiely, Patrick D.W.; Walsh, David A.; Young, Adam

Abstract

Objectives: To assess 5-year progression of erosions and Joint Space Narrowing (JSN), and their associations with RF status in two large, multi-centre early-RA cohorts spanning 25-years.

Methods: Radiographic joint damage was recorded using the Sharp/van der Heijde (SvdH) method in the Early RA Study (ERAS) 1986-2001, and the Early RA Network (ERAN) 2002-2013. Mixed-effects negative-binomial regression estimated changes in radiographic damage over 5-years, including erosions and JSN separately. Rheumatoid Factor (RF), along with age, sex and baseline markers of disease activity were controlled for.

Results: 1,216 patients from ERAS and 446 from ERAN had radiographic data. Compared to ERAS, ERAN patients had a lower mean total SvdH score at baseline (ERAN=6.2 vs. ERAS=10.5, p<0.001), and mean annual rate of change (ERAN=2.5 vs. ERAS=6.9 per year, p<0.001). 74% of ERAS and 27% of ERAN patients progressed ≥5 units. Lower scores at baseline in ERAN were largely driven by reductions in JSN (ERAS=3.9 vs. ERAN=1.2, p<0.001), along with erosions (ERAS=1.9 vs. ERAN=0.8, p<0.001). RF was associated with greater progression in each cohort, but the absolute difference in mean annual rate of change for RF positive patients was substantially higher for ERAS (RF+= 8.6 vs. RF-= 5.1, p<0.001), relative to ERAN (RF+= 2.0 vs. RF-= 1.9, p=0.855).

Conclusion: Radiographic progression has significantly reduced between the two cohorts, associated with lower baseline damage and other factors, including changes in early DMARD use. The impact of RF status as a prognostic marker of clinically meaningful change in radiographic progression has markedly diminished in the context of more modern treatment. This article is protected by copyright. All rights reserved.

Citation

Carpenter, L., Norton, S., Nikiphorou, E., Jayakumar, K., McWilliams, D. F., Rennie, K. L., Dixey, J., Kiely, P. D., Walsh, D. A., & Young, A. (2017). Reductions in radiographic progression in early RA over 25-years: changing contribution from RF in 2 multi-centre UK inception cohorts. Arthritis Care and Research, 69(12), 1809-1817. https://doi.org/10.1002/acr.23217

• Journal Article Type: Article
• Acceptance Date: Feb 17, 2017
• Online Publication Date: Feb 19, 2017
• Publication Date: Dec 1, 2017
• Deposit Date: Mar 20, 2017
• Publicly Available Date: Mar 20, 2017
• Journal: Arthritis Care & Research
• Print ISSN: 2151-464X
• Electronic ISSN: 2151-4658
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 69
• Issue: 12
• Pages: 1809-1817
• DOI: https://doi.org/10.1002/acr.23217
• Public URL: https://nottingham-repository.worktribe.com/output/964146
• Publisher URL: http://onlinelibrary.wiley.com/doi/10.1002/acr.23217/abstract
• Additional Information: This is the peer reviewed version of the following article: eductions in radiographic progression in early RA over 25-years: Changing contribution from RF in 2 multi-centre UK inception cohorts / Lewis Carpenter, Sam Norton, Elena Nikiphorou, Keeranur Jayakumar, Daniel F McWilliams, Kirsten L Rennie, Josh Dixey, Patrick Kiely, David Andrew Walsh, Adam Young MD and on behalf of ERAS & ERAN, which has been published in final form at [http:dx.doi.org/10.1002/acr.23217. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
• Contract Date: Mar 20, 2017