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J Clin Med. 2018 Mar 13;7(3). pii: E57. doi: 10.3390/jcm7030057.

Long-Term Increase of Radiographic Damage and Disability in Patients with RA in Relation to Disease Duration in the Era of Biologics. Results from the SCQM Cohort.

Author information

1
Division of Rheumatology, Immunology and Rehabilitation, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland. katja@heinimann.ch.
2
Division of Rheumatology, Immunology and Rehabilitation, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland. johannes.vonkempis@kssg.ch.
3
Clinical Trials Unit, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland. rafael.sauter@gmail.com.
4
School of Medicine, University of Colorado, Denver, CO 80111, USA. michael.schiff@me.com.
5
Faculty of Health Sciences, Jyvaskyla Central Hospital, University of Eastern Finland, 40620 Jyvaskyla, Finland. tuulikki.sokka-isler@ksshp.fi.
6
Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, Ludwig-Maximilians-University Munich, Pettenkoferstr. 8a, 80336 Munich, Germany. Hendrik.Schulze-Koops@med.uni-muenchen.de.
7
Division of Rheumatology, Immunology and Rehabilitation, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland. ruediger.mueller@kssg.ch.
8
Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, Ludwig-Maximilians-University Munich, Pettenkoferstr. 8a, 80336 Munich, Germany. ruediger.mueller@kssg.ch.

Abstract

OBJECTIVES:

There is little information on the relation between disease duration, disability and radiographic outcome since the introduction of biologics into the therapy of rheumatoid arthritis (RA). No long -term cohort studies have been conducted on this subject so far. To analyse radiographic damage, disability, and disease activity in RA-patients dependent on disease duration in the Swiss national RA cohort (SCQM).

METHODS:

The primary outcome was the association between the radiographic destruction, assessed by Ratingen scores, and disease duration. All patients with at least one clinical visit were analysed with polynomial and multiple negative binomial models.

RESULTS:

The disease duration in the 8678 patients with available radiographs analysed ranged between less than 1 and more than 65 years (median 8.3). Disease duration and radiographic destruction were significantly associated with an average increase of Ratingen scores by 8.3% per year. Apart from disease duration, positive rheumatoid factor was the strongest predictor for radiographic destruction. While DAS28-scores remained stable in patients with a disease duration of more than 5 years (median DAS28 2.8), HAQ-DI scores increased continuously by 0.018 for each additional year.

CONCLUSION:

In this RA cohort, patients show a continuous increase of articular destruction and physical disability in parallel with disease duration. Even when nowadays a satisfactory control of disease activity can be achieved in most patients, RA remains a destructive disease leading to joint destruction and physical disability in many patients.

KEYWORDS:

ACPA; DAS28; HAQ-DI; Ratingen score; disease duration; radiographic destruction; rheumatoid arthritis; rheumatoid factor

Conflict of interest statement

The authors have nothing to disclose that directly or indirectly might affect, or be perceived to affect, the conduct or reporting of the work they have submitted.

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