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Predictors of joint damage in patients with early rheumatoid arthritis treated with high-dose methotrexate with or without concomitant infliximab: results from the ASPIRE trial.

Publication ,  Journal Article
Smolen, JS; Van Der Heijde, DMFM; St Clair, EW; Emery, P; Bathon, JM; Keystone, E; Maini, RN; Kalden, JR; Schiff, M; Baker, D; Han, C; Han, J ...
Published in: Arthritis Rheum
March 2006

OBJECTIVE: To identify disease characteristics leading to progression of joint damage in patients with early rheumatoid arthritis (RA) treated with methotrexate (MTX) versus those treated with infliximab plus MTX. METHODS: Patients who had not previously been treated with MTX with active RA were randomly assigned to receive escalating doses of MTX up to 20 mg/week plus placebo or infliximab at weeks 0, 2, and 6, and every 8 weeks thereafter through week 46. Radiographic joint damage was assessed using the modified Sharp/van der Heijde score (SHS). The relationship between disease activity measures at baseline and week 14, as well as those averaged over time, were examined in relation to the change in SHS from baseline through week 54. RESULTS: C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), and swollen joint count were associated with greater joint damage progression in the MTX-only group, while none of these parameters was associated with progression in the infliximab plus MTX group. Mean changes in SHS among patients in the highest CRP (> or = 3 mg/dl) and ESR (> or = 52 mm/hour) tertiles in the MTX-only group were 5.62 and 5.89, respectively, compared with 0.73 and 1.12 in the infliximab plus MTX group (P < 0.001). Patients with greater joint damage at baseline (SHS > or = 10.5) showed less progression with infliximab plus MTX compared with MTX alone (-0.39 versus 4.11; P < 0.001). Patients receiving MTX alone who had persistently active disease at week 14 showed greater radiographic progression of joint damage than those taking MTX plus infliximab. CONCLUSION: High CRP level, high ESR, or persistent disease activity was associated with greater radiographic progression in the group taking MTX alone, while little radiographic progression was seen in patients receiving both MTX and infliximab, regardless of the abnormal levels of these traditional predictors.

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Published In

Arthritis Rheum

DOI

ISSN

0004-3591

Publication Date

March 2006

Volume

54

Issue

3

Start / End Page

702 / 710

Location

United States

Related Subject Headings

  • Radiography
  • Middle Aged
  • Methotrexate
  • Male
  • Infliximab
  • Humans
  • Female
  • Disease Progression
  • C-Reactive Protein
  • Blood Sedimentation
 

Citation

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Smolen, J. S., Van Der Heijde, D. M. F. M., St Clair, E. W., Emery, P., Bathon, J. M., Keystone, E., … Active-Controlled Study of Patients Receiving Infliximab for the Treatment of Rheumatoid Arthritis of Early Onset (ASPIRE) Study Group, . (2006). Predictors of joint damage in patients with early rheumatoid arthritis treated with high-dose methotrexate with or without concomitant infliximab: results from the ASPIRE trial. Arthritis Rheum, 54(3), 702–710. https://doi.org/10.1002/art.21678
Smolen, Josef S., Désirée M. F. M. Van Der Heijde, E William St Clair, Paul Emery, Joan M. Bathon, Edward Keystone, Ravinder N. Maini, et al. “Predictors of joint damage in patients with early rheumatoid arthritis treated with high-dose methotrexate with or without concomitant infliximab: results from the ASPIRE trial.Arthritis Rheum 54, no. 3 (March 2006): 702–10. https://doi.org/10.1002/art.21678.
Smolen JS, Van Der Heijde DMFM, St Clair EW, Emery P, Bathon JM, Keystone E, et al. Predictors of joint damage in patients with early rheumatoid arthritis treated with high-dose methotrexate with or without concomitant infliximab: results from the ASPIRE trial. Arthritis Rheum. 2006 Mar;54(3):702–10.
Smolen, Josef S., et al. “Predictors of joint damage in patients with early rheumatoid arthritis treated with high-dose methotrexate with or without concomitant infliximab: results from the ASPIRE trial.Arthritis Rheum, vol. 54, no. 3, Mar. 2006, pp. 702–10. Pubmed, doi:10.1002/art.21678.
Smolen JS, Van Der Heijde DMFM, St Clair EW, Emery P, Bathon JM, Keystone E, Maini RN, Kalden JR, Schiff M, Baker D, Han C, Han J, Bala M, Active-Controlled Study of Patients Receiving Infliximab for the Treatment of Rheumatoid Arthritis of Early Onset (ASPIRE) Study Group. Predictors of joint damage in patients with early rheumatoid arthritis treated with high-dose methotrexate with or without concomitant infliximab: results from the ASPIRE trial. Arthritis Rheum. 2006 Mar;54(3):702–710.
Journal cover image

Published In

Arthritis Rheum

DOI

ISSN

0004-3591

Publication Date

March 2006

Volume

54

Issue

3

Start / End Page

702 / 710

Location

United States

Related Subject Headings

  • Radiography
  • Middle Aged
  • Methotrexate
  • Male
  • Infliximab
  • Humans
  • Female
  • Disease Progression
  • C-Reactive Protein
  • Blood Sedimentation