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Patients with RA, low DAS28 may have risk for joint failure similar to patients with high DAS28

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Patients with rheumatoid arthritis who had low to high-moderate disease activity in the first 5 years of disease were found to have as much risk for later joint failure as patients with high disease activity, according to research from Elena Nikiphorou, MD, MRCP, and colleagues.

Researchers studied the records of orthopedic surgery as a surrogate marker for joint failure in 2,044 patients with rheumatoid arthritis (RA) from the Early RA Study (ERAS, 1986 to 1999) and the Early RA Network (ERAN, 2002 to 2012) in the U.K. Clinical radiology and laboratory data were collected for up to 25 years from ERAS and up to 10 years in ERAN. The databases were validated using the National Joint Registry and the Hospital Episode Statistics and National Death Register.

Elena Nikiphorou

Patient data were collected, including Disease Activity Score in 28 Joints (DAS28), course of treatment, and the use of conventional or biologic disease-modifying anti-rheumatic drugs (DMARDs). Mean DAS28 was calculated per patient for year 1 through year 5 and classified as remission (DAS28 <2.6), low (DAS28 >2.6 and <3.2), low-moderate (DAS28 >3.2 and <4.19), high-moderate (DAS28 >4.2 and <5.1) and high (DAS28 >5.1).

Joint surgeries were identified and classified as major for large joint replacements; intermediate for synovectomies or arthroplasty in the hands, wrists, and hind or forefoot; and as minor in soft tissue.

Multivariate Cox regression models adjusted for age at disease onset, gender, BMI, symptom duration, the presence of rheumatoid factor at baseline, Health Assessment Questionnaire scores, hemoglobin and the number of erosions showed that high-moderate or high DAS28 were predictive of later intermediate surgery. However, the risk for major joint surgery was similar in patients with low DAS28 (hazard ratio [HR] = 2.07), high-moderate DAS28 (HR = 21.6) and high DAS28 (HR = 2.48).

“Patients who remain in low or high-moderate disease activity levels in the first 5 years of disease, despite conventional DMARD therapy, have similar risks for joint failure and surgery as those with persistently high DAS,” the researchers wrote. “This is highly relevant in health systems where restrictions exist in the use of biologic DMARDs, which are based on DAS cut-offs and exclude moderate RA.” – by Shirley Pulawski

Reference:

Nikiphorou E, et al. Paper #OP0179. Presented at: European League Against Rheumatism Annual European Congress of Rheumatology; June 10-13, 2015; Rome.

Disclosure: The researchers report no relevant financial disclosures.