Annals of the Rheumatic Diseases | 2019
FRI0688\u2005PREDICTORS OF EROSION AND JOINT SPACE NARROWING PROGRESSION IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS
Abstract
Background Joint damage in rheumatoid arthritis (RA) includes erosions and joint space narrowing (JSN). Predictors of these processes, and the underlying mechanisms, require further study1. Objectives To investigate the relation between patient characteristics at RA diagnosis and progression of erosions and JSN, over 5 years. Methods Consecutive early RA patients (symptom duration <12 months), recruited 1995-2005 from a defined area, managed according to usual care with no pre-specified treatment protocol, were followed through 5 years. Radiographs of hands and feet were scored in chronological order by a trained reader according to the modified Sharp-van der Heijde score (SHS), including separate erosion- and JSN scores. The relations between baseline variables and progression of erosion- and JSN scores over 5 years (log transformed), were assessed using linear regression. Results 233 early RA patients where included. Radiographs at baseline and 5 years were available for 162 patients. Results on predictors of rapid radiographic progression of the total SHS have been reported previously2. The median (interquartile) progression of erosion and JSN scores were 4 (0-8) and 8 (1-16), respectively. RF and anti-CPP predicted progression of erosions and JSN over 5 years, with stronger associations for erosions (Table 1). Baseline erosion- and JSN scores each predicted progression of JSN, while baseline JSN did not predict progression of erosions. In crude analyses, higher disease activity, CRP and ESR were associated with progression of both erosions and JSN, while statistically more robust for the former. Smoking and high levels of Cartilage Oligomeric Matrix Protein (COMP) (>12 U/L) were both associated with progression of erosions ((B= 0.12, p= 0.016) and (B= 0.12, p= 0.02) respectively) but not JSN, in adjusted analyses (Table 1). Overweight or obesity (BMI >25kg/m2) was associated with less progression of JSN (B= -0.14, p= 0.018, adjusted for RF, age and baseline JSN score).Table 1 Baseline predictors of progression of erosion and JSN scores (log transformed) from baseline to 5 years in linear regression Erosion score JSN score Baseline characteristics Crude Adjusted for RF and baseline erosion score Crude Adjusted for RF, age and baseline JSN score B p B p B p B p Age (per SD) 0.02 0.39 0.02 0.45 0.06 0.051 NA NA Overweight or obese vs. normal BMIa -0.05 0.34 -0.03 0.62 -0.14 0.03 -0.14 0.018 Ever vs. never smokers 0.16 0.004 0.12 0.016 0.05 0.49 0.06 0.33 RF positivity 0.23 <0.001 NA NA 0.18 0.004 NA NA Anti-CCP positivity 0.23 <0.001 0.13 0.02 0.17 0.008 0.09 0.18 COMP >12 U/L 0.10 0.08 0.12 0.02 0.08 0.24 0.08 0.23 Erosion score (per SD) 0.07 0.006 NA NA 0.12 <0.001 0.08 0.02 JSN score (per SD) 0.04 0.12 -0.01 0.69 0.11 <0.001 NA NA High vs. moderate DAS28b 0.17 0.003 0.12 0.03 0.14 0.04 0.12 0.054 ESR (per SD) 0.11 <0.001 0.08 0.002 0.09 0.003 0.06 0.04 CRP >9 mg/l (median)c 0.15 0.003 0.09 0.08 0.13 0.03 0.07 0.26 NA, not applicable; vs, versus. a Overweight or obese >25 kg/m2; normal 18.5 – 24.99 kg/m2. b High >5.1; moderate >3.2 to ≤5.1. Conclusion RF, anti-CCP and markers of inflammation and disease activity predicted progression of erosions and JSN, in particular erosions. Development of erosions may predate cartilage damage leading to JSN. Smoking and high baseline levels of COMP predicted progression of erosions, but not JSN. Overweight and obesity may be associated with mechanisms that protect from JSN. References [1] Smolenet al, Ann Rheum Dis. 2009;68:1535-40.2 Rydell et al, Arthritis Res Ther. 2018;20:82. Disclosure of Interests Emil Rydell: None declared, Kristina Forslind: None declared, Jan-Åke Nilsson: None declared, Lennart T.H. Jacobsson Consultant for: LJ has received lecture and consulting fees from Pfizer, Abbvie, Novartis, Eli-Lily and Janssen, Carl Turesson: None declared