Influence of disease-modifying therapy on radiographic outcome in XXXX at five years: results from a large observational inception study.

@entity1 @entity32 @entity625
OBJECTIVE: To determine the effect of early treatment with disease-modifying antirheumatic drugs (DMARDs) in reducing radiographic progression over a 5-year period in @entity1 with new-onset @entity32 . METHODS: Three hundred thirty-five consecutive @entity1 with paired radiographs obtained 1 year and 5 years after enrollment in a population-based @entity625 register were studied. Logistic regression was used to model differences in baseline factors associated with the start of DMARDs. The time from symptom onset to first use of DMARDs was stratified to represent 4 groups: no DMARD use, <6 months, 6-12 months, and >12 months. Radiographs of the hands and feet were scored using the Larsen method. Progression in the Larsen score was evaluated as a 5-year score adjusted for the first film score. Negative binomial regression was used to compare Larsen score progression for each of the 3 treatment groups with that for @entity1 not receiving DMARDs. Results were then adjusted for severity, based on propensity modeling. RESULTS: @entity1 who received treatment had more radiographic progression than did @entity1 who were untreated. Coefficients (95% confidence intervals), expressed as a multiple of the Larsen score in DMARD-treated @entity1 compared with untreated @entity1 , were as follows: 1.6 (1.1-2.3) for <6 months, 2.4 (1.5-3.6) for 6-12 months, and 2.0 (1.4-2.8) for >12 months. As expected, @entity1 receiving treatment had more severe disease at baseline. Using the propensity score as a method of adjusting for disease severity, the influence of treatment on outcome became attenuated as follows: 1.1 (0.8-1.7) for <6 months, 1.6 (1.0-2.6) for 6-12 months, and 1.5 (1.0-2.2) for >12 months. This effect was also seen in the crude Larsen score at year 5. CONCLUSION: In this observational study, DMARD treatment was a marker not only of worse disease at presentation but also of the radiographic state and radiographic progression at 5 years. After adjustments were made for baseline disease severity, earlier therapy was shown to have a beneficial effect on outcome.
