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First Year Radiological Erosive
Progression Is a New Predictor of Further Erosive Progression in
Early Arthritis: Results of the ESPOIR Cohort
Gabriel Tobon, Unit of immunology, Brest, France,
Alain Saraux, Brest Occidentale University, Brest, France, Cédric
Lukas, Montpellier 1 University, Lapeyronie Hospital, 371, Avenue
du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France,
Montpellier, France, Frédérique Gandjbakhch, Hopital Pitié
Salpétrière, Paris, France, Xavier Mariette, Université Paris-Sud,
Le Kremlin Bicetre, France, Bernard G. Combe, Hopital Lapeyronie,
Montpellier, France and Valerie Devauchelle-Pensec, Brest
Occidentale university, Brest, France
Presentation Number:
2235
Background/Purpose: One of a major
goal in the treatment of recent arthritis is to prevent articular
destruction. Several factors exist to predict joint destruction,
but the rapidity of progression is never taken account.
Our objective was to determine if the
first year radiological erosive progression (FIRE) is a predictor
of further erosive progression (FURE) during the next two years in
a cohort of early arthritis.
Method: 813 patients with
a diagnosis of recent arthritis of less than 6 months were included
in the prospective French “ESPOIR” cohort. Standardized radiographs
of hand wrist and foot in postero-anterior view (PAV) were
performed at inclusion, one, two and three years. Inter and
intraobserver variabilities were assessed. All the radiographs were
examined by a blinded reader for modified Sharp score. The speed of
progression was defined at one year (between M0 and M12) and after
the next two years (between M12 and M36). The patients with a speed
of annual progression of more than 2.5 in the erosion Sharp score
were considered as high progressors.
Result: 535 patients have
a complete set of radiographs. Among them 7% (35/500) received
biological treatment before one year. None of them was FURE. For
the 500 remaining patients without biologics, 55/500 (11%) were
FIRE. During the first year, 37/500 (7.4%) did not have
radiographic progression, 25% (124/500) were
rapid progressor (> 5pts) Concerning classification
criteria, only the presence of RF and the item 7 of the ACR
criteria, or the serological item and the ACR/EULAR score of the
ACR/EULAR criteria were associated with a FURE. Using logistic
regression, the presence of RF or ACPA (p= 0.023), erosion at
inclusion (p=0.001), the level of IL-6 (p= 0.043) and FIRE (p=
0.002) were associated with FURE. When items were combined, the
FIRE criteria performed better than other criteria to predict
further rapid progression.
Conclusion: The first
year radiological erosive progression should be considered as a new
predictor of further erosive progression in early
arthritis
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第1年的放射学侵蚀进展是早期RA进一步侵蚀性进展的新预测指标
Gabriel Tobon , et al. Present
No:2235
背景/目的:早期关节炎的主要治疗目标之一是预防关节破坏。
已知多个因素可以预测关节破坏，但破坏的速度尚未得到关注。
我们的目的是要确定早期关节炎队列中，第一年放射学侵蚀进展(FIRE)是否为今后2年进一步侵蚀进展(FURE)的一种预测指标。
方法:813例诊断为早期关节炎（少于6个月）的患者纳入法国前瞻性研究队列“ESPOIR”。入组时、第1、2和3年时分别行标准化的手腕和足影像学前后（PAV）位摄片。评价患者自身和患者间的变量。 所有的影像学检查都由1位阅片者盲法评估改良的Sharp积分。进展的速度定义为1年(M0和M12之间)和随后两年（M12和M36之间)的Sharp积分变化。年进展速度超过2.5 Sharp侵蚀指数的患者被视为高进展者。
结果:535例患者有完整的的影像学资料。其中7%(35/500)患者1年前接受生物制剂治疗。无1例判为FURE。其余500例患者未用生物制剂,其中55/500(11%)例为FIRE。在第一年,37/500(7.4%)例患者没有放射学进展,25%(124/500)按分类标准有快速进展(> 5pts),只有RF阳性、ACR标准第7条、或血清学指标和ACR /EULAR标准的评分与FURE有关。回归分析中，RF或ACPA阳性(p =
0.023)、入组时侵蚀病变(p = 0.001)、IL-6水平(p = 0.043)和FIRE(p = 0.002)与FURE相关。当上述指标结合在一起, FIRE标准比其它的标准能更好地预测快速进展
。
结论:第一年放射学侵蚀进展应该被认为早期关节炎进一步进展的新预测指标。
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