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Radiographic remission in rheumatoid arthritis quantified by computer-aided joint space analysis (CASJA): a post hoc analysis of the RAPID 1 trial

  • Pfeil, Alexander1
  • Nussbaum, Anica1
  • Renz, Diane M.2
  • Hoffmann, Tobias1
  • Malich, Ansgar3
  • Franz, Marcus1
  • Oelzner, Peter1
  • Wolf, Gunter1
  • Böttcher, Joachim4, 4
  • 1 Jena University Hospital – Friedrich Schiller University Jena, Am Klinikum 1, Jena, 07747, Germany , Jena (Germany)
  • 2 Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany , Hannover (Germany)
  • 3 Suedharz-Hospital Nordhausen, Dr. Robert-Koch-Straße 38, Nordhausen, 99734, Germany , Nordhausen (Germany)
  • 4 University Jena, Am Klinikum 1, Jena, 07747, Germany , Jena (Germany)
Published Article
Arthritis Research & Therapy
Springer Science and Business Media LLC
Publication Date
Oct 06, 2020
DOI: 10.1186/s13075-020-02322-9
Springer Nature


BackgroundThe reduction of finger joint space width (JSW) in patients with rheumatoid arthritis (RA) is strongly associated with joint destruction. Treatment with certolizumab pegol (CZP), a PEGylated anti-TNF, has been proven to be effective in RA patients. The computer-aided joint space analysis (CAJSA) provides the semiautomated measurement of joint space width at the metacarpal-phalangeal joints (MCP) based on hand radiographs. The aim of this post hoc analysis of the RAPID 1 trial was to quantify MCP joint space distance (JSD-MCP) measured by CAJSA between baseline and week 52 in RA patients treated with certolizumab pegol (CZP) plus methotrexate (MTX) compared with MTX/placebo.MethodsThree hundred twenty-eight patients were included in the post hoc analysis and received placebo plus MTX, CZP 200 mg plus MTX and CZP 400 mg plus MTX. All patients underwent X-rays of the hand at baseline and week 52 as well as assessment of finger joint space narrowing of the MCP using CAJSA (Version 1.3.6; Sectra; Sweden). The joint space width (JSW) was expressed as mean joint space distance of the MCP joints I to V (JSD-MCPtotal).ResultsThe MTX group showed a significant reduction of joint space of − 4.8% (JSD-MCPtotal), whereas in patients treated with CZP 200 mg/MTX and CZP 400 mg/MTX a non-significant change (JSD-MCPtotal + 0.6%) was observed. Over 52 weeks, participants with DAS28 remission (DAS28 ≤ 2.6) exhibited a significant joint space increase of + 3.3% (CZP 200 mg plus MTX) and + 3.9% (CZP pegol 400 mg plus MTX).ConclusionCZP plus MTX did not reduce JSD-MCPtotal estimated by CAJSA compared with MTX/placebo. Furthermore, clinical remission (DAS28 ≤ 2.6) in patients treated with CZP plus MTX was associated with an increasing JSD, indicating radiographic remission in RA.

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