• Lykke Midtbøll Ørnbjerg, Mikkel Østergaard, Pernille Bøyesen, Niels Steen Krogh, Anja Thormann, Ulrik Tarp, Uta Engling Poulsen, Jakob Espesen, Annette Schlemmer, Niels Graudal, Gina Kollerup, Dorte Vendelbo Jensen, Ole Rintek Madsen, Bente Glintborg, Torben Christensen, Hanne Lindegaard, Wolfgang Bøhme, Annette Hansen, Anne Rødgaard Andersen, and Merete Lund Hetland.
• From the DANBIO registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Zitelab Aps, Copenhagen; Department of Rheumatology, Aarhus University Hospital, Aarhus; Rheumatism Hospital, University of Southern Denmark, Gråsten; Department of Internal Medicine, Lillebælt Hospital, Vejle; Department of Rheumatology, Aarhus University Hospital, Aalborg; Department of Rheumatology, Copenhagen University Hospital Rigshospitalet; Department of Rheumatology, Copenhagen University Hospital Frederiksberg, Copenhagen; Department of Rheumatology, Helsingør Hospital, Helsingør; Department of Rheumatology/C, Copenhagen University Hospital Gentofte, Hellerup; Department of Internal Medicine, Holbæk Hospital, Holbæk; Department of Rheumatology, Copenhagen University Hospital Slagelse, Slagelse; Department of Rheumatology, Odense University Hospital, Odense; Department of Medicine, Hospital of South West Jutland, Esbjerg; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Glostrup, Glostrup, Denmark.L.M. Ørnbjerg, MD; M. Østergaard, MD, PhD, DMSc; A. Thormann, MD; M.L. Hetland, MD, PhD, DMSc, DANBIO registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; P. Bøyesen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; N.S. Krogh, consultant, Zitelab Aps; U. Tarp, MD, DMSc, Department of Rheumatology, Aarhus University Hospital; U.E. Poulsen, MD, Rheumatism Hospital, University of Southern Denmark; J. Espesen, MD, Department of Internal Medicine, Lillebælt Hospital; A. Schlemmer, MD, Department of Rheumatology, Århus University Ho
• J Rheumatol. 2014 Dec 1; 41 (12): 2352-60.

ObjectiveTo investigate baseline characteristics associated with radiographic progression and the effect of disease activity, drug, switching, and withdrawal on radiographic progression in tumor necrosis factor (TNF) inhibitor-naive patients with rheumatoid arthritis (RA) followed for about 2 years after anti-TNF initiation in clinical practice.MethodsDANBIO-registered patients with RA who had available radiographs (anti-TNF initiation and ∼2 yrs followup) were included. Radiographs were scored, blinded to chronology with the Sharp/van der Heijde method and linked with DANBIO data. Baseline characteristics were investigated with univariate regression and significant variables included in a multivariable logistic regression analysis with ± radiographic progression [Δ total Sharp score (TSS) > 0] as dependent variable. Effect of time-averaged C-reactive protein (CRP), 28-joint Disease Activity Score with CRP (DAS28-CRP), and treatment status at followup were investigated with univariate regression analysis.ResultsThe study included 930 patients. They were 75% women, 79% positive for IgM-rheumatoid factor (IgM-RF), median age was 57 yrs (range 19-88), disease duration 9 yrs (1-59), DAS28-CRP 5.0 (1.4-7.8), TSS median 15 [3-45 interquartile range (IQR)] and mean 31 (SD 40). Patients started treatment with infliximab (59%), etanercept (18%), or adalimumab (23%). At followup (median 526 days, IQR 392-735), 61% were treated with the initial anti-TNF, 29% had switched TNF inhibitor, and 10% had withdrawn. Twenty-seven percent of patients had progressed radiographically. ΔTSS was median 0.0 [0.0-0.5 IQR/mean 0.6 (SD 2.4)] units/year. Higher TSS, older age, positive IgM-RF, and concomitant prednisolone at baseline were associated with radiographic progression. Time-averaged DAS28-CRP and time-averaged CRP, but not type of TNF inhibitor, were associated with radiographic progression. Patients who stopped/switched during followup progressed more than patients who continued treatment.ConclusionHigh TSS, older age, IgM-RF positivity, and concomitant prednisolone were associated with radiographic progression during 2 years of followup of 930 anti-TNF-treated patients with RA in clinical practice. High disease activity and switching/stopping anti-TNF treatment were associated with radiographic progression.

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