Carpenter, Lewis, Norton, Sam, Nikiphorou, Elena, Jayakumar, Keeranur, McWilliams, Daniel F., Rennie, Kirsten L., Dixey, Josh, Kiely, Patrick D.W., Walsh, David A. and Young, Adam
(2017)
Reductions in radiographic progression in early RA over 25-years: changing contribution from RF in 2 multi-centre UK inception cohorts.
Arthritis Care & Research, 69
(12).
pp. 1809-1817.
ISSN 2151-4658
Abstract
Objectives: To assess 5-year progression of erosions and Joint Space Narrowing (JSN), and their associations with RF status in two large, multi-centre early-RA cohorts spanning 25-years.
Methods: Radiographic joint damage was recorded using the Sharp/van der Heijde (SvdH) method in the Early RA Study (ERAS) 1986-2001, and the Early RA Network (ERAN) 2002-2013. Mixed-effects negative-binomial regression estimated changes in radiographic damage over 5-years, including erosions and JSN separately. Rheumatoid Factor (RF), along with age, sex and baseline markers of disease activity were controlled for.
Results: 1,216 patients from ERAS and 446 from ERAN had radiographic data. Compared to ERAS, ERAN patients had a lower mean total SvdH score at baseline (ERAN=6.2 vs. ERAS=10.5, p<0.001), and mean annual rate of change (ERAN=2.5 vs. ERAS=6.9 per year, p<0.001). 74% of ERAS and 27% of ERAN patients progressed ≥5 units. Lower scores at baseline in ERAN were largely driven by reductions in JSN (ERAS=3.9 vs. ERAN=1.2, p<0.001), along with erosions (ERAS=1.9 vs. ERAN=0.8, p<0.001). RF was associated with greater progression in each cohort, but the absolute difference in mean annual rate of change for RF positive patients was substantially higher for ERAS (RF+= 8.6 vs. RF-= 5.1, p<0.001), relative to ERAN (RF+= 2.0 vs. RF-= 1.9, p=0.855).
Conclusion: Radiographic progression has significantly reduced between the two cohorts, associated with lower baseline damage and other factors, including changes in early DMARD use. The impact of RF status as a prognostic marker of clinically meaningful change in radiographic progression has markedly diminished in the context of more modern treatment. This article is protected by copyright. All rights reserved.
| Item Type: |
Article
|
| Additional Information: |
This is the peer reviewed version of the following article: eductions in radiographic progression in early RA over 25-years: Changing contribution from RF in 2 multi-centre UK inception cohorts / Lewis Carpenter, Sam Norton, Elena Nikiphorou, Keeranur Jayakumar, Daniel F McWilliams, Kirsten L Rennie, Josh Dixey, Patrick Kiely, David Andrew Walsh, Adam Young MD and on behalf of ERAS & ERAN, which has been published in final form at [http:dx.doi.org/10.1002/acr.23217. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. |
| Schools/Departments: |
University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Rheumatology, Orthopaedics and Dermatology |
| Identification Number: |
https://doi.org/10.1002/acr.23217 |
| Depositing User: |
McWilliams, Daniel
|
| Date Deposited: |
20 Mar 2017 11:32 |
| Last Modified: |
19 Feb 2018 23:38 |
| URI: |
https://eprints.nottingham.ac.uk/id/eprint/41376 |
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