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Repair of joint erosions in patients with RA occurs primarily in joints with no swelling, improvement in swelling, researchers report

Friday, June 15 2007 | Comments

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What's This? Repair of joint erosions among patients with rheumatoid arthritis appears to occur almost exclusively in joints without swelling or in those that show improvement in swelling, whereas progression occurs in joints with persistent swelling, according to a post hoc analysis of preliminary data from the TEMPO study.

In the study, 686 patients with RA were randomized to receive etanercept 25 mg twice weekly, methotrexate at a dosage of up to 20 mg weekly, or a combination of methotrexate plus etanercept. Radiographic data from baseline, 1 year, and 2 years were available for 642 participants, and researchers in the current study examined single-joint readings of the hands/wrists and feet from these participants.

Each radiograph was evaluated twice by 2 readers blinded to treatment and true-time sequence using Sharp/van der Heijde scoring. Repair in a joint was considered to have occurred if there was a negative change in erosion score in >=1 of the 4 potential readings, with the remaining readings showing no progression. The goal of the current study was to determine whether joint repair truly occurs and, if so, whether it occurs more often in joints with no swelling or improvements in swelling.

Of the 11,159 single-joint readings, 557 showed repair. Swelling scores were available for 553 of these joints.

Of the joints that showed repair, 234 joints exhibited no change in swelling; 12 joints had residual swelling and 222 had no swelling. Among the 318 joints that exhibited improvement in swelling, only 36 joints had residual swelling. Repair was highly significantly more associated with improvement in swelling than no repair (P<.0001), according to Dr. Desiree van der Heijde, the lead researcher.

Mean changes in erosion scores among joints with no swelling or an improvement in swelling consisted of a decrease of 0.09 (95% CI, -0.11 to -0.06) among the subgroup of joints with baseline damage and an increase of 0.01 (95% CI,0.00-0.01) among those without baseline damage. These compared with increases of 0.06 (95% CI, -0.02 to 0.14) and 0.03 (95% CI, 0.01-0.04) among the subgroups of joints with persistent swelling that did and did not have baseline damage, respectively. Mean changes in erosion score were only significantly negative in the subgroup of joints with absent or improving swelling that had baseline erosions present.

These results were maintained in a multivariate analysis, according to Dr. van der Heijde, and similar results were observed with respect to joint space narrowing.

"So, this is indeed circumstantial evidence that repair ... indeed exists," Dr. van der Heijde concluded. "It was also clear that the positive change in scores rarely occurred in joints that had persistent swelling." (Abstract #OP0011.)

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