BRIGHTON, England -- Treatment of early arthritis with a combination regimen of methotrexate and the tumor necrosis factor inhibitor adalimumab (Humira) both suppressed inflammation and prevented damage to bone and cartilage, researchers said here.
Among patients receiving methotrexate alone in a study known as PREMIER, increases in joint damage correlated with increases in disease activity scores in 28 joints (DAS28), with lower scores for joint space narrowing at one year (0.60) being seen for patients in the lowest quartile of disease activity, and the highest scores (3.97) being seen among those in the highest quartile.
In contrast, mean scores for joint space narrowing at one year among patients on combination therapy were 0.52 and 0.53 in the lowest and highest disease activity quartiles, according to Robert Landewé, MD, of University Hospital Maastricht in the Netherlands, and colleagues.
The benefits of combination therapy with methotrexate and the tumor necrosis factor inhibitor adalimumab in inhibiting bone damage "may result from effects on osteoclasts/osteoclast precursor cells and chondrocytes, which are involved in bone and cartilage destructive processes, respectively," they explained in a poster session at the annual meeting of the British Society for Rheumatology.
Physical functioning in patients with rheumatoid arthritis relates to both inflammatory disease activity and radiographic progression, which includes damage to bone, as measured by erosions, and damage to cartilage, as seen on joint space narrowing.
Whether the typically permanent articular damage that occurs even early in rheumatoid arthritis is primarily mediated through effects on cartilage or bone has not previously been determined, so Landewé and colleagues conducted a post-hoc analysis of a trial that included 525 patients.
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