In a nutshell
The authors assessed predictive factors in the progression of rheumatoid arthritis (RA) 1 year after diagnosis.
Some background
In RA, high levels of immune system proteins are generated. This causes inflammation, leading to chronic pain and structural damage in the joints. An X-ray based imaging technique called ‘radiography’ can assess the extent of joint inflammation. Hence the progression of joint damage in RA is called ‘radiographic progression’. This is measured by a scoring system known as Sharp-van der Hejde Score (SHS). This indicates the degree of erosion and narrowing of space between the bones due to cartilage breakdown. A SHS score of 5 or more indicates radiographic progression.
To control inflammation in the early stage of RA, disease-modifying anti-rheumatic drugs (DMARDs) are used as a safe and effective treatment option. Despite treatment, some patients may still experience radiographic progression.
An understanding of the underlying risk factors in RA is important for determining appropriate treatment.
Methods & findings
The authors aimed to evaluate the factors that predict radiographic progression of RA, 1 year after diagnosis.
311 RA patients were included in this study. None of the patients had previously received DMARDs. At the beginning of the study, the DAS28 score for all patients was greater than 3.2. DAS28 is an assessment used to measure the progress and improvement of RA by examining 28 joints.
All patients received methotrexate (Trexall) at the beginning of the study. 269 patients had a high risk of disease progression. Among them, 80 patients continued to take methotrexate. 95 patients received a combination of sulfasazaline (Azulfidine) and hydroxychloroquinoline (Plaquenil) in addition to methotrexate. 94 patients received infliximab (Remicade) in addition to methotrexate.
79 patients experienced radiographic progression. Those who had bone erosion (breakdown) were at a 2.29 times higher risk of experiencing progression. Patients who had higher red blood cell sedimentation (settling down) rates were at a 1.72 times higher risk of experiencing RA progression. Patients with increased C-reactive protein levels (a protein in blood elevated during inflammation) had a 1.52 times higher risk of experiencing RA progression. Patients who smoked had a 2.17 times higher risk of experiencing RA progression. Patients who had none of the above predictive risk factors (bone erosion, red blood cell sedimentation, smokers and increased C-reactive protein) had a 12% risk of experiencing RA progression. Patients who had 1, 2 or all of these predictive factors had a 63% risk of disease progression.
The bottom line
The authors concluded that in addition to already established risk factors, smoking was a strong risk factor for radiographic progression in early RA.
Published By :
Annals of the rheumatic diseases
Date :
Apr 09, 2014