PT - JOURNAL ARTICLE AU - Lykke Midtbøll Ørnbjerg AU - Mikkel Østergaard AU - Pernille Bøyesen AU - Niels Steen Krogh AU - Anja Thormann AU - Ulrik Tarp AU - Uta Engling Poulsen AU - Jakob Espesen AU - Annette Schlemmer AU - Niels Graudal AU - Gina Kollerup AU - Dorte Vendelbo Jensen AU - Ole Rintek Madsen AU - Bente Glintborg AU - Torben Christensen AU - Hanne Lindegaard AU - Wolfgang Bøhme AU - Annette Hansen AU - Anne Rødgaard Andersen AU - Merete Lund Hetland TI - Which Factors Influence Radiographic Progression During Treatment with Tumor Necrosis Factor Inhibitors in Clinical Practice? Results from 930 Patients with Rheumatoid Arthritis in the Nationwide Danish DANBIO Registry AID - 10.3899/jrheum.131299 DP - 2014 Oct 01 TA - The Journal of Rheumatology PG - jrheum.131299 4099 - http://www.jrheum.org/content/early/2014/09/25/jrheum.131299.short 4100 - http://www.jrheum.org/content/early/2014/09/25/jrheum.131299.full AB - Objective To investigate baseline characteristics associated with radiographic progression and the effect of disease activity, drug, switching, and withdrawal on radiographic progression in tumor necrosis factor (TNF) inhibitor-naive patients with rheumatoid arthritis (RA) followed for about 2 years after anti-TNF initiation in clinical practice. Methods DANBIO-registered patients with RA who had available radiographs (anti-TNF initiation and ~2 yrs followup) were included. Radiographs were scored, blinded to chronology with the Sharp/van der Heijde method and linked with DANBIO data. Baseline characteristics were investigated with univariate regression and significant variables included in a multivariable logistic regression analysis with ± radiographic progression [Δ total Sharp score (TSS) > 0] as dependent variable. Effect of time-averaged C-reactive protein (CRP), 28-joint Disease Activity Score with CRP (DAS28-CRP), and treatment status at followup were investigated with univariate regression analysis. Results The study included 930 patients. They were 75% women, 79% positive for IgM-rheumatoid factor (IgM-RF), median age was 57 yrs (range 19–88), disease duration 9 yrs (1–59), DAS28-CRP 5.0 (1.4–7.8), TSS median 15 [3–45 interquartile range (IQR)] and mean 31 (SD 40). Patients started treatment with infliximab (59%), etanercept (18%), or adalimumab (23%). At followup (median 526 days, IQR 392–735), 61% were treated with the initial anti-TNF, 29% had switched TNF inhibitor, and 10% had withdrawn. Twenty-seven percent of patients had progressed radiographically. ΔTSS was median 0.0 [0.0–0.5 IQR/mean 0.6 (SD 2.4)] units/year. Higher TSS, older age, positive IgM-RF, and concomitant prednisolone at baseline were associated with radiographic progression. Time-averaged DAS28-CRP and time-averaged CRP, but not type of TNF inhibitor, were associated with radiographic progression. Patients who stopped/switched during followup progressed more than patients who continued treatment. Conclusion High TSS, older age, IgM-RF positivity, and concomitant prednisolone were associated with radiographic progression during 2 years of followup of 930 anti-TNF–treated patients with RA in clinical practice. High disease activity and switching/stopping anti-TNF treatment were associated with radiographic progression.