Lesser joint space narrowing in older women with RA compared to young: Study

The findings have been put forth in Arthritis Research & Therapy.

Radiographic damage in rheumatoid arthritis (RA) includes erosions and joint space narrowing (JSN). Different mechanisms may underlie their development. The presence of autoantibodies such as rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPAs), higher disease activity measures, and levels of systemic inflammation are considered other established risk factors for worse radiological outcomes. RA-related joint damage includes erosions and cartilage destruction, with the latter causing joint space narrowing (JSN). Despite that separate scores of these are included in the commonly used radiographic scoring methods , most previous studies have evaluated only combined total scores of the radiographic damage.

With this background,The objective of this study was to evaluate predictors of these entities separately.

An inception cohort of 233 consecutive patients with early RA was investigated. The catchment area was the city of Malmö, Sweden (population 259,579 in 2000). Patients were recruited from the rheumatology outpatient clinic of Skåne University Hospital Malmö, the only hospital serving the city, or from the four rheumatologists in private practice in the area, between 1995 and 2005.

The patients were diagnosed with RA by a specialist in rheumatology, fulfilled the 1987 American College of Rheumatology (ACR) classification criteria for RA  and had duration of symptoms ≤ 12 months at the time of inclusion (baseline). There were no additional exclusion criteria.

Data analysis revealed the following facts.

• Two hundred and thirty-three patients were included. Radiographs at baseline and 5 years were available for 162 patients.
• The median (interquartile) progression of erosion and JSN scores were 4 (0–8) and 8 (1–16), respectively.
• Rheumatoid factor (RF) was a robust significant predictor of both erosion and JSN score progression.
• In adjusted analyses, anti-CCP antibodies predicted erosions while the erythrocyte sedimentation rate was predictive of both outcomes. Smoking and high baseline disease activity (DAS28 > 5.1) predicted progression of erosions.
• Baseline erosion score was associated with progression of both erosion and JSN progression, while baseline JSN score was predictive only of the progression of JSN.
• Overweight/obesity (BMI ≥ 25 kg/m²) was a significant negative predictor of JSN score progression (β = − 0.14, p = 0.018, adjusted for RF, age, baseline JSN score) also when additionally adjusting for ever smoking (p = 0.041).
• Among female patients, this effect was observed in those of estimated post-menopausal age (> 51 years), but not in younger women.
• The truncal to peripheral fat ratio was associated with less JSN score progression in women, but not in men.

"Truncal fat was associated with less JSN progression in female patients. Smoking predicted erosion progression, and erosions may precede JSN. BMI and fat distribution may influence cartilage damage in early RA and might be related to hormonal factors."the team concluded.

For the full article follow the link: https://doi.org/10.1186/s13075-020-02413-7

Primary source: Arthritis Research & Therapy