Impact of early radiographic remission on the 15-year radiographic outcome in patients with rheumatoid arthritis.

OBJECTIVE

To investigate the 15-year radiographic outcome in patients with rheumatoid arthritis (RA) in relation to early radiographic remission.

METHODS

A cohort of 87 patients with RA, treated with early-initiated disease-modifying anti-rheumatic drug (DMARD) therapy, was followed up prospectively for 15 years. Radiographs of hands and feet were taken at baseline and at 1, 2, 3, 5, 7, 10, and 15 years, and radiographs of large joints at 15 years. Radiographic outcome was assessed by the Larsen score (LS). Early radiographic remission was defined as a change of ≤ 1 Larsen unit in a year, during the first 2 years.

RESULTS

A complete set of radiographs for evaluation was available from 69 patients. Outcome was evaluated in three groups: group A comprised 18 (26%) patients with sustained early radiographic remission (at both year 1 and year 2); group B comprised 20 (29%) patients with temporary early radiographic remission (at either year 1 or year 2); and group C comprised 31 (45%) patients with no early radiographic remission. Radiographic outcome was most favourable in patients with sustained early radiographic remission. The mean change in LS over 15 years was 11 [95% confidence interval (CI) 0-22] in group A, 30 (95% CI 12-51) in group B, and 62 (95% CI 45-81) in group C (p < 0.001). A similar relationship to large joint damage (Larsen large joint score) was seen.

CONCLUSIONS

Compared with patients with progressive erosions, our results indicate that early radiographic remission relates to a better long-term radiographic outcome in RA regarding both small joint and large joint changes.