Radiographic progression and remission rates in early rheumatoid arthritis – MRI bone oedema and anti-CCP predicted radiographic progression in the 5-year extension of the double-blind randomised CIMESTRA trial

• Published in: Annals of the rheumatic diseases Vol. 69; no. 10; pp. 1789 - 1795
• Main Authors: Hetland, Merete L, Stengaard-Pedersen, Kristian, Junker, Peter, Østergaard, Mikkel, Ejbjerg, Bo J, Jacobsen, Søren, Lottenburger, Tine, Hansen, Ib, Tarp, Ulrik, Andersen, Lis S, Svendsen, Anders, Pedersen, Jens K, Lauridsen, Ulrik B, Ellingsen, Torkell, Lindegaard, Hanne, Pødenphant, Jan, Vestergaard, Aage, Jurik, Anne Grethe, Hørslev-Petersen, Kim
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.10.2010; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Adult; Aged; Antirheumatic Agents - adverse effects; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - diagnostic imaging; Arthritis, Rheumatoid - drug therapy; Autoantibodies - blood; Biological and medical sciences; Biomarkers - blood; Bone marrow; Bone Marrow Diseases - diagnosis; Bone Marrow Diseases - etiology; Cyclosporine - adverse effects; Cyclosporine - therapeutic use; Disease Progression; Diseases of the osteoarticular system; Drug Therapy, Combination; Edema - diagnosis; Edema - etiology; Epidemiologic Methods; Female; Humans; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Inflammatory joint diseases; Magnetic Resonance Imaging; Male; Medical sciences; Methotrexate - adverse effects; Methotrexate - therapeutic use; Middle Aged; Patients; Peptides, Cyclic - immunology; Prognosis; Radiography; Remission Induction; Rheumatoid arthritis; Rheumatology; Studies; Immunopathology; Prognosis; Radiodiagnosis; Diseases of the osteoarticular system; Rheumatology; Exploration; Autoimmune disease; Inflammatory joint disease; Nuclear magnetic resonance imaging; Extension; Radiography; Chronic; Rheumatoid arthritis; Medical imagery; Evolution; Remission; Bone; Predictive factor
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.2009.125534

Objective At 5 years' follow-up of early (<6 months) rheumatoid arthritis patients to (1) investigate whether initial combination therapy with methotrexate (MTX) and ciclosporin (CSA) (n=80) is superior to initial monotherapy with MTX (n=80) with respect to prevention of radiographic progression, (2) investigate whether the favourable clinical and radiographic response reported at 2 years in the CIMESTRA trial can be maintained and (3) identify predictors of radiographic outcome. Methods 139 patients completed 5 years' follow-up with maintained double-blinding and a strict synovitis suppressive treatment strategy with intra-articular betamethasone injections (intra-articular glucocorticosteroid (GC)) and escalation of disease-modifying anti-rheumatic drug treatment. Disease activity, total Sharp-van der Heijde Score (TSS) of hands, wrists and forefeet were assessed at baseline and after 3, 4 and 5 years. MRI of the wrist and anti-cyclic citrullinated peptide (anti-CCP) were assessed at baseline. Results At 5 years, TSS progression rate was <1 unit/year and 47% had not progressed radiographically since baseline. 78% were in Disease Activity Score remission, 56% in American College of Rheumatology remission and 17% withdrawn from treatment due to remission. There were no differences between initial treatment groups. MRI-bone marrow oedema, TSS and anti-CCP predicted radiographic progression at 5 years. Conclusion Early and strict synovitis suppressive treatment with MTX and intra-articular GC lead to high remission rates and halting of erosive progression at 5 years. No additional effect of initial combination therapy with CSA was found. The results parallel those reported for tumour necrosis factor α antagonists. Baseline MRI-bone oedema, TSS and anti-CCP predicted radiographic progression.