Bone erosions in rheumatoid arthritis can be repaired through reduction in disease activity with conventional disease-modifying antirheumatic drugs

Abstract

We conducted the present study to determine whether repair of erosions occurs in patients with rheumatoid arthritis (RA) treated with conventional disease-modifying anti-rheumatic drugs (DMARDs) and to compare clinical characteristics between patients exhibiting and not exhibiting erosion repair. We included in the study a total of 122 RA patients who fulfilled the 1987 American College of Rheumatology criteria for RA; all patients had paired sequential radiographs of both hands and wrists showing erosive changes at baseline. Patients were classified into two groups according to the presence of repair of erosions at follow up, namely the 'repair observed' and 'repair not observed' groups. Clinical characteristics, disease activity, radiographic scores and treatment in the two groups were compared. Forty-four repairs were observed in 13 patients (10.7%). Compared with the repair not observed group, the functional class of the patients in the repair observed group was lower at baseline (P < 0.01) and the mean disease activity was lower at follow up (P < 0.005). The changes in radiographic scores per year (total radiographic score and erosion score) were lower (P < 0.05 and P < 0.01, respectively) in the repair observed group. No difference in treatment was observed. Repair of erosions was detected in 10.7% of RA patients treated with conventional DMARDs. Repairs were associated with low functional class at baseline and low disease activity at follow up. These observations support the importance of reduction in disease activity in RA patients. Because repair of erosions was detected in a substantial number of patients, assessment of erosion repair should be incorporated into the radiographic evaluation and scoring of RA.

Figure 1

Analysis of DAS28-3 values. The DAS28-3 values at baseline and follow up are shown for the 'repair observed' and 'repair not observed' groups. For the repair observed group the mean ± standard deviation (solid horizontal lines and bars) and median (interquartile range [35]; dashed horizontal lines and boxed areas) DAS28-3 values at baseline were 4.4 ± 1.2 and 4.4 (3.4–5.7), respectively; at follow up they were 2.7 ± 1.1 and 2.7 (2.0–3.2). For the repair not observed group the mean ± standard deviation and median (interquartile range) DAS28-3 values at baseline were 4.0 ± 1.1 and 4.1 (3.4–4.7), respectively; at followup they were 3.7 ± 1.2 and 3.7 (2.9–4.5). *P < 0.005, ^†P < 0.001, ^‡P < 0.005 (determined by the Student's t test). DAS, Disease Activity Score.

Figure 2

Differences in the radiographic progression in vdH-S. The mean ± standard deviation (solid horizontal lines and bars) and median (interquartile range [35]; dashed horizontal lines and boxed areas) change in total radiographic score/year were 4.1 ± 4.0 and 4.0 (1.1–6.0) in the repair observed group, respectively; they were 9.3 ± 10.0 and 7.0 (3.5–9.9) in the repair not observed group (*P < 0.05). The mean ± standard deviation and median (interquartile range) change in erosion score/year were 1.1 ± 2.2 and 1.0 (0.0–2.3) in the repair observed group, respectively; they were 5.2 ± 7.6 and 2.7 (1.1–6.1) in the repair not observed group (^†P < 0.01). The mean ± standard deviation and median (interquartile range) change in JSN score/year were 3.1 ± 3.0 and 3.9 (1.2–5.0) in the repair observed group, respectively; they were 4.1 ± 4.4 and 3.0 (1.0–5.6) in the repair not observed group (not significant).

Figure 3

Probability plot: change/year in total radiographic score.

Figure 4

Probability plot: change/year in erosion score.

Figure 5

Probability plot: change/year in JSN score. JSN, joint space narrowing.

Figure 6

Diagram of the left hand showing sites where erosion repair was observed. The dorsal aspect of the left hand is shown: A = base of middle phalanx, B = head of proximal phalanx, C = base of proximal phalanx, D = head of metacarpal bone, E = base of metacarpal bone, F = hamate bone, G = scaphoid bone, H = lunate bone, I = distal radius, and J = distal ulna.

Figure 7

Recortication and filling in at a right fourth PIP joint. Images of the same hand are shown from (a) October 2002 and (b) November 2003. PIP, proximal interphalangeal.