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Open Access Research article

Clinical and radiological dissociation of anti-TNF plus methotrexate treatment in early rheumatoid arthritis in routine care: Results from the ABRAB study

Péter Juhász12, Ádám Mester1, Anna-Julianna Biró3, Gábor Héjj1 and Gyula Poór14*

Author Affiliations

1 National Institute of Rheumatology and Physiotherapy, Budapest, Hungary

2 School of PH.D. studies, Semmelweis University, Budapest, Hungary

3 Clinic of Rheumatology, University of Medicine and Pharmacy, Târgu Mureş, Romania

4 3rd Department of Internal Medicine, Chair of Rheumatology, Semmelweis University, Budapest, Hungary

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BMC Musculoskeletal Disorders 2014, 15:251  doi:10.1186/1471-2474-15-251

Published: 24 July 2014

Abstract

Background

Rheumatoid arthritis (RA) is a chronic autoinflammatory joint disease which leads to the destruction of joints and disability of the patients. Anti-tumour necrosis factor (anti-TNF) drugs can halt radiological progression better than conventional DMARDs even in clinical non-responders.

Methods

The efficacy of anti-TNF plus methotrexate (MTX) treatment versus MTX monotherapy on clinical and radiological outcomes were compared in early rheumatoid arthritis (RA) patients in clinical practice by retrospective analysis of an observational cohort.

49 early RA patients (group A) on first-line MTX monotherapy and 35 early RA patients (group B) on anti-TNF plus MTX treatment were selected from an observational cohort and evaluated retrospectively focusing on their first twelve months of treatment. Data on disease activity (DAS28) and functional status (HAQ-DI) were collected three monthly. One-yearly radiological progression was calculated according to the van der Heijde modified Sharp method (vdHS). Clinical non-responder patients in both groups were selectively investigated from a radiological point of view.

Results

Disease activity was decreased and functional status was improved significantly in both groups. One-yearly radiological progression was significantly lower in group B than in group A. The percentage of patients showing radiological non-progression or rapid radiological progression demonstrated a significant advantage for group B patients. In addition non-responder patients in group B showed similar radiological results as responders, while a similar phenomenon was not observed in patients in group A.

Conclusions

Clinical efficacy within our study was similar for tight-controlled MTX monotherapy as well as for combination treatment with anti-TNF and MTX. However MTX monotherapy was accompanied by more rapid radiological progression and less radiological non-progression. Anti-TNF plus MTX decreased radiological progression even in clinical non-responders supporting the advantage of anti-TNF plus MTX combination in dissociating clinical and radiological effects.

Keywords:
Rheumatoid arthritis; Anti-TNF plus MTX treatment versus MTX; Radiological progression; Clinical and radiological dissociation; Treatment outcome; Routine care