| Abstrakt: |
OBJECTIVE and DESIGN This study examines the effects of biological DMARDs (bDMARDs) on joint damage after 5 or more years since rheumatoid arthritis (RA) diagnosis. Long term joint damage is compared in patients who have never used bDMARDs and patients who have used bDMARDs. Joint damage is measured with the Rheumatoid Arthritis Articular Damage (RAAD) score, a non-radiographic method in a retrospective cohort study. METHODS RA patients > 18 years who were diagnosed with RA from 1 January 2004 to 31 December 2011 by the rheumatologist in the Hospital Group Twente were included. Further inclusion criteria were prescription for a DMARD, a minimum follow-up of 5 years, and at least one RAAD score available. Exclusion criteria were discarding RA diagnosis during follow-up and receiving a DMARD for any other indication than RA. The exposure of interest was the type of treatment: synthetic (sDMARD) or biologic DMARD. RESULTS 305 patients were included in this cohort, of which 101 used a bDMARD. Baseline characteristics were not significantly different in terms of prognostic factors for joint damage progression, with the exception of age; patients in the bDMARD group were significantly younger. During follow-up, the highest disease activity score (DAS28) was significantly higher in the bDMARD group (median = 5.0, IQR = 4.2 – 5.8 versus 4.3, 2.9 – 5.1; P < 0.001).No significant differences in long term joint damage were observed (b = –0.15, 95% CI = –0.9 – 0.6; P = 0.69), even after adjusting for potential confounders like DAS28, gender, age, rheumatoid factor and smoking habits (b = –0,26, 95% CI = –1.9 – 1.4; P = 0.76). CONCLUSION Long term joint damage by RA was not significantly different between patients who were treated with sDMARDs and patients who had an addition of a bDMARD to the treatment with a sDMARD. [ABSTRACT FROM AUTHOR] |
