Moderate RA Progresses Despite Methotrexate Use

Article

Rheumatoid arthritis patients with sustained moderate disease, despite two-three years of methotrexate treatment, are at risk for significant radiographic progression, a new study shows.

Rheumatoid arthritis patients with sustained moderate disease, despite two-three years of methotrexate treatment, are at risk for significant radiographic progression, a new study shows. The study, published in the July 28, 2015 issue of Rheumatic and Musculoskeletal Diseases, shows that patients with sustained moderate rheumatoid arthritis (RA), despite having received methotrexate treatment (MTX), are at risk of significant radiographic progression (SRP). MTX is the most common first-line treatments for RA and it is an important one. It is considered to be a drug anchor in which anti-rheumatic drugs and biologics bind to, however, it has long been associated with inhibiting radiographic progression. The challenge for physicians has been in determining which patients will respond to MTX.  

How might this impact clinical practice?

  • The identification of predictors of SRP could

facilitate early, aggressive treatment wherenecessary and avoid unnecessary treatmentescalation in patients with moderate activity atlow/no risk of SRP.Even lists.

Source:  Rheumatic and Musculoskeletal Diseases

[[{"type":"media","view_mode":"media_crop","fid":"40134","attributes":{"alt":"","class":"media-image media-image-left","id":"media_crop_9244799136649","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4074","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.0080003738403px; line-height: 1.538em; float: left;","title":" ","typeof":"foaf:Image"}}]]This new study, led by Dr. Bruno Fautrel of Hôpital Pitié-Salpêtrière in Paris, focuses on patients with sustained moderate RA and MTX treatment. The study included 228 patients who were prescribed MTX of which 96 patients had sustained moderate RA. SRP occurred in 25 (26%) and 33 (34%) patients after 2 and 3 years of MTX treatment, respectively. The study is based on an analysis of the Trial of Etanercept and Methotrexate with Radiographic Patient Outcomes (TEMPO) trial, a double-blind, randomized, 3-year multi-center study. “Patients with higher CRP and RF positivity could achieve better results if they switched to more aggressive therapy sooner rather than continuing on MTX alone,” Dr. Bruno and colleagues wrote. In patients with SRP after three years, the mean age was 51. The matrix risk model showed that rheumatoid factor (RF) levels and C-reactive protein (CRP) levels of greater than 40 mg/L at baseline, were significantly associated with SRP after 2 (p<0.05 for both; R2=0.24) and 3 years (p<0.05 for both; R2=0.22). The baseline erosion score was not found to be predictive of SRP. While RF positivity and high CRP (greater than 40 mg/L) levels at the start of the study were strongly predictive of radiographic progression, the patients’ mTSS joint erosion scores were not, the researchers wrote.   

References:

Fautrel B, Nab HW, Braukt Y, et al. Identifying patients with rheumatoid arthritis with moderate disease activity at risk of significant radiographic progression despite methotrexate treatment.Rheumatic and Musculoskeletal Diseases. July 28, 2015. doi:10.1136/rmdopen-2014-000018.

Related Videos
© 2024 MJH Life Sciences

All rights reserved.