LAUSR

Background We have demonstrated that TNF-blocking therapies are effective in inhibiting the radiographic progression in weight-bearing large joints with pre-existing Larsen grade 0-II during short term follow-up1,2). However, it is not clarified that the observed effect is persistent during long-term TNF-blocking therapies. Objectives The purpose of this study is to assess radiographic progression of weight-bearing large joint damage in patients with rheumatoid arthritis during long-term TNF-blocking therapies. Methods Sixty two consecutive patients (7 male, 55 women, mean age of 59.5 years old) were evaluated at baseline and after TNF-blocking therapy (infliximab, etanercept, adalimumab and golimumab). Joints that had undergone surgical intervention or ankylosis before the initiation of TNF-blocking therapy were excluded from the radiographic analysis. We assessed the radiographic progression of 327 weight-bearing large joints (109 hip joints, 99 knee joints, 119 ankle joints) at baseline and every year after TNF-blocking therapy. The structural damage in the weight-bearing large joints was evaluated using the Larsen grade (LG) at baseline. Radiographic progression of joint damage was defined as ARASHI change score3) except bone quality score ≥1. Survival rate was analysed using Kaplan-Meier method and the end point was defined as progression of joint damage. Results Average follow-up period was 7.0 years (rang, 1~12 years). Analysis of hip and knee joints with baseline LG 0/I indicated that 12 year survival rates were 93.4% and 84.1%, respectively. Radiographic progression was limited to cases with poor clinical response. All of the hip and knee joints with pre-existing damage of LG III/IV showed rapid progression at 1 year. Hip joint with baseline LG II showed gradual progression of damage. Two and 5 year survival rates of hip joint with LG II were 60.0% and 0%, respectively. Knee joint with baseline LG II also showed slow progression. Two, 5- and 9 year survival rates of knee joint with LG II were 81.3%, 48.2% and 0%, respectively. On the other hand, the radiographic progression of ankle joint damage was not significantly related to pre-existing damage. Twelve-year survival rates of ankle joint with baseline LG 0/I, II and III/IV were 81.6%, 75.0% and 82.4%, respectively. Conclusions In hip and knee joint, it was sometimes difficult to inhibit the progression when the baseline Larsen grade had been at II-IV. Therefore, it is essential to pay attention to the occurrence of early radiographic damage to avoid progression of hip and knee joint destruction. References [1] Seki E., Matsushita I, Sugiyama E, et al. Clin Rheumatol. 2009; 28(4):453–60. [2] Matsushita I, Motomura H, Seki E, et al. Mod Rheumatol. 2017; 27: 570–75. [3] Kaneko A, Matsusita I, Kanbe K, et al. 2013; 23: 1053–62. Disclosure of Interest None declared