Moller B, et al. - Experts evaluated the low blood haemoglobin concentrations as a predictor of radiographic damage progression in patients with rheumatoid arthritis (RA). In MTX-treated patients with early RA, low haemoglobin was a DAS28-CRP-independent predictor of radiographic joint damage progression. In adalimumab (ADA)- and combination-treated patients and in clinical responders, this effect decreased over time irrespective of treatment modality.

Methods

• Authors performed a post hoc analyses in patients from the PREMIER trial with early RA undergoing 2 years of adalimumab (ADA), methotrexate (MTX), or ADA + MTX combination therapy.
• They defined the low disease activity a score <3.2 on the 28-joint Disease Activity Score using the C-reactive protein level (DAS28-CRP), and clinical response by the American College of Rheumatology criteria for 20% improvement at week 24.
• They analyzed baseline or mean hemoglobin concentrations over time, or anemia as defined using sex-specific World Health Organization criteria, in mixed-effects models for longitudinal data in men and women as predictors of progressive joint damage, as measured by the modified total Sharp/van der Heijde score (ΔSHS).
• For treatment and other patient characteristics, including the DAS28-CRPm, data were adjusted.

Results

• Findings suggested an inverse association of baseline hemoglobin with ΔSHS in adjusted analyses (P < 0.05 for both sexes).
• As per data, greater ΔSHS was predicted by baseline anemia in MTX-treated patients over 104 weeks, and in ADA- and combination-treated patients over 26 weeks.
• Results demonstrated an association of lower hemoglobin concentrations over time, and time with anemia, with greater damage progression (P < 0.001).
• Even in patients achieving low disease activity, the effect of low hemoglobin concentrations on joint damage progression remained significant.