Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Irreversible Physical Disability in Rheumatoid Arthritis (RA) Is Determined by Cartilage Damage Rather Than Bone Destruction.
Smolen2, Josef S., Aletaha1, Daniel
RA is characterized by joint damage leading to irreversible disability (assessed by health assessment questionnaire [HAQ]). Joint destruction is comprised of cartilage and bone damage, consequences of distinct pathogenetic mechanisms. They are evaluated by joint space narrowing (JSN) and erosion (ERO) components of the Sharp score. We aimed to determine the contribution of cartilage and bone damage to irreversible disability.
We evaluated data from randomized controlled clinical trials (ASPIRE, ATTRACT, DE019, ERA, Leflunomide, PREMIER, TEMPO). We extracted patients who were in stringent remission by the simplified disease activity index (SDAI<=3.3) to eliminate the activity-related component of disability. In these patients, we determined the residual HAQ at the time of remission (irreversible disability1) and the JSN and ERO scores at baseline. We then compared effects of ERO and JSN on residual HAQ (across tertiles using ANOVA, and in regression models).
Mean residual HAQ in remission increased across tertiles of JSN and ERO (ERO: 0.21, 0.25, 0.35 JSN: 0.19, 0.24, 0.39; p<0.001 for both). In patient groups formed according to JSN tertiles, increasing ERO scores did not lead to an increase in irreversible HAQ (for example, mean residual HAQ in the middle JSN tertile: 0.24, 0.24 and 0.23 for 1st, 2nd and 3rd ERO tertile, respectively; p=ns). In contrast, within each ERO tertile, increasing JSN was associated with an increase in residual HAQ (Figure 1). This relationship was maintained when adjustments for residual disease activity, age or disease duration were done (data not shown).
Figure 1. HAQ values in remission ("irreversible HAQ") as attained when grouping patients by ERO or JSN tertiles and within each ERO terile by JSN tertiles and vice versa. Note that increasing JSN conveyed higher irreversible HAQ within each ERO tertile but not vice versa.
Irreversible physical disability is primarily mediated by cartilage and not bony damage, suggesting that therapeutic attention should be given to interference with cartilage destruction.
We thank Abbott, Amgen, Centocor, Sanofi-Aventis and Pfizer-Wyeth for providing us with data of their clinical trials and Farideh Alasti for statistical support.
To cite this abstract, please use the following information:
Smolen, Josef S., Aletaha, Daniel; Irreversible Physical Disability in Rheumatoid Arthritis (RA) Is Determined by Cartilage Damage Rather Than Bone Destruction. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2256