Tumor necrosis factor–blocking therapies appear to inhibit the radiographic progression of damage to large, weight-bearing joints in rheumatoid arthritis patients who have low-grade damage scores, and the agents may even reverse damage in certain joints, according to Dr. Isao Matsush*ta.
Radiographs in 38 consecutive RA patients that were taken of 232 weight-bearing joints—including 63 hips, 51 knees, 67 ankles, and 51 subtalar joints—showed progression of damage in 34 joints (14.7%) at 2 years, as well as in 37 joints (15.9%) at 3 years in the patients, who were evaluated at baseline and after treatment with infliximab or etanercept.
Repair of joint damage was noted in six ankles and two subtalar joints, said Dr. Matsush*ta of the University of Toyama (Japan).
An analysis by baseline damage grade showed that progression was “practically inhibited” by TNF-blocking therapy in patients with a Larsen damage score of 0/1, but that rapid progression occurred despite therapy in hip and knee joints with preexisting grade III/IV damage, Dr. Matsush*ta explained in an interview. In most cases, joint damage did not progress in the hips and knees of patients with Larsen scores of 0-II. The exception was in patients with highly active RA, in which joint damage occurred over the 3 years of follow-up despite a low Larsen score at baseline and TNF blockade, he said.
Wwhen disease activity was high at 1 year after therapy initiation, more than 60% of joints showed the progression of structural damage at 2- and 3-year follow-up.
Joints with ankylosis or a history of surgical intervention were excluded from the study. Structural damage was assessed using both the Larsen scoring method and comparative evaluation of erosions and joint-space narrowing on the radiographs. Radiographic progression was defined as the appearance of new erosion and/or the enlargement of erosions above 2 mm and/or joint space narrowing above 2 mm, he said.
The findings are important, because although TNF-blocking therapy has been shown to inhibit disease progression in smaller joints of the hands and feet, its effects on large, weight-bearing joints have been unclear until now. “Damage to weight-bearing joints, such as hip, knee, and ankle joints, is strongly associated with walking disability, and therefore can have adverse effects on activities of daily living in rheumatoid arthritis patients,” he said. These findings suggest that—in certain patients with lower grade damage and lower disease activity—TNF inhibitors may be effective for halting and even reversing joint damage, he said. “Early intervention and tight control by TNF-blocking therapy may be necessary to effectively prevent radiographic progression in weight-bearing joints of rheumatoid arthritis.”
http://www.rheumatologynews.com/article/S1541-9800(10)70342-2/fulltext
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