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Low hemoglobin predicts radiographic damage progression in early rheumatoid arthritis - Secondary analysis from a phase III trial

Arthritis Care & Research Oct 05, 2017

Moller B, et al. - In this research, authors study low blood hemoglobin concentrations as an indicator of radiographic damage progression in patients with rheumatoid arthritis (RA). The outcome of this study suggests that low hemoglobin is a DAS28-CRP-independent indicator of radiographic joint damage progression in MTX-treated patients with early RA. This impact reduces over time in ADA- and in combination-treated patients, and in clinical responders irrespective of treatment modality.

Methods

  • For this study, they performed Post-hoc analyses in patients from the PREMIER trial with early RA undergoing two years of adalimumab (ADA), methotrexate (MTX), or ADA+MTX combination therapy.
  • In this study, low disease activity was characterized by the 28-joint based disease activity score DAS28-CRP <3.2, and clinical response by 20% improvement in the American College of Rheumatology response criteria at week 24.
  • Baseline or mean hemoglobin concentrations over time, or anemia as characterized utilizing sex-specific World Health Organization criteria, were investigated in mixed impact models for longitudinal data in men and women as predictors of progressive joint damage, as measured by modified total Sharp scores (ΔmTSS).
  • Information were adjusted for treatment and other patient attributes, including the DAS28-CRP.

Results

  • The current study showed that the baseline hemoglobin was inversely connected with ΔmTSS in adjusted analyses (P <0.05 for both sexes).
  • Baseline anemia predicted higher ΔmTSS in MTX-treated patients more than 104 weeks, and in ADA- and combination-treated patients more than 26 weeks.
  • Lower hemoglobin concentrations over time, and ‘time-with-anemia’ were both related to greater damage progression (P <0.001).
  • The impact of low hemoglobin concentrations on joint damage progression remained significant, even in patients achieving low disease activity.

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