Radiographic progression (RP) has been an important objective outcome for assessing the comparative efficacy of therapies in clinical trials. It is being increasingly reported in observational studies of clinical care. RP is typically reported as a change in a modified version of the Sharp score (SS)1. Reported rates and extent of RP are much lower in patients with rheumatoid arthritis (RA) treated intensively, to a target of low disease activity or remission while receiving disease-modifying antirheumatic drugs (DMARD), including more effective doses of methotrexate (MTX)2. However, persisting swelling of ≥ 2 (of 28) joints is associated with further RP (defined as a change > 0.5 over 1 year) using SS scoring methods3. RP continues throughout the course of RA4, although less often for patients who are in remission more often5. RP reporting varies widely, using different cutoffs such as the smallest detectable change (SDC) to describe “rapid radiographic progression” (RRP)6. Thus rates of RP will vary depending on study design, patients studied, disease activity, and intensity of treatment interventions.
In this issue of The Journal, Ørnbjerg, et al publish additional results from the Danish Biologics Registry (DANBIO) on the rate and extent of RP in patients with serial hand radiographs using tumor necrosis factor (TNF) inhibitor (TNFi) therapy over an average of 1.5 years7. Ørnbjerg, et al aimed to understand the effect on RP of drug switching and withdrawal. Prior analyses had shown that the extent and rate of RP dropped significantly once patients failing DMARD switched to TNFi therapy8. DANBIO patients had longstanding disease of 9 years, higher than usual rates of smoking (38%), high C-reactive protein (CRP) levels for DMARD and steroid-treated patients, and 82% in this study had erosive disease. …
Address correspondence to Dr. Bykerk. E-mail: bykerkv{at}hss.edu