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The effect of different treatment options on joint involvement in SSc

Hands are commonly affected in SSc patients evolving into significant disability. In particular, arthralgia, arthritis, joint contractures and tendon friction rubs are contributors to impairment of hand function. Therefore, the objective of this retrospective study was to investigate the effects of different treatments on joint involvement ‒ defined as arthritis, joint contractures and/or tendon friction rubs ‒ in SSc patients

Short summary

Short summary

Background

Hands are commonly affected in SSc patients evolving into significant disability. In particular, arthralgia, arthritis, joint contractures and tendon friction rubs are contributors to impairment of hand function.

Therefore, the objective of this retrospective study was to investigate the effects of different treatments on joint involvement ‒ defined as arthritis, joint contractures and/or tendon friction rubs ‒ in SSc patients. We intended to examine the effectiveness of currently used therapeutic approaches in the management of patients with joint involvement in a retrospective analysis of the EUSTAR SSc cohort.

Methods

The data of the EUSTAR MEDSonline database from June 2004 up to April 2012 have been analyzed. Patients fulfilling the ACR classification criteria of SSc have been included if they received one of the following drugs or combinations of drugs on at least 2 visits 12 ± 1 months apart from one another:

  1. methotrexate (MTX) with or without low-dose corticosteroids, without biologic therapy (study group 1)

  2. azathioprine with or without low-dose corticosteroids, without biologic therapy (study group 2)

  3. mycophenolate with or without low-dose corticosteroids, without biologic therapy (study group 3)

  4. low-dose corticosteroids without DMARDs, without biologic therapy (study group 4)

  5. rituximab with or without DMARDs, with or without corticosteroids (study group 5)

  6. imatinib with or without DMARDs, with or without corticosteroids (study group 6)

  7. TNF-alpha antagonist with or without DMARDs, with or without corticosteroids (study group 7)

  8. no DMARD, biologic or corticosteroid treatment (control group) (study group 8)

Preliminary Results

From the pre-planned 8 study-groups we could only analyse five groups, because there were not enough patients with follow-up within 12 ± 1 months in study groups 5, 6 and 7 (n=24, 4 and 16, respectively). With regard to the remaining study groups, a decrease in the prevalence of joint synovitis over the time could be observed in all treatment groups including the control group. The decrease was most prominent in study group 1. However, the decrease was found to be statistically significant only in the control group (p=0.014). The lowest prevalence of synovitis could be observed in study groups 2 and 3. In contrast, as expected, the prevalence of joint contractures did not decrease over time in most treatment arms. However, in study group 3 the prevalence of contractures decreased by 13%, although this was not statistically significant. Another interesting tendency was that the number of contractures did not increase in the control group in contrast to study groups 1, 2, and 4. With regard to tendon friction rubs, a reduction could be observed in study groups 1, 4 and the control group; however, this was only statistically significant in study group 4 (p=0.022)

Preliminary Conclusion

In many groups it was not possible to draw any conclusion because of the lack of reliable, well-defined data. Corticosteroid treatment seemed to show some efficacy with regard to the improvement of tendon friction rubs. Although no statistical difference was demonstrated, methotrexate (and maybe some other immunomodulating drugs as well) may have some effect on the treatment of synovitis. These findings need  to be interpreted with caution due to the limitation of the retrospective nature of this analysis. In particular, the definitions of synovitis, joint contractures and tendon friction rubs have not been clearly specified, and different groups used different criteria for these particular items causing a patient reporting bias. However, the available data indicate that certain drugs may be efficient in the treatment of synovitis and tendon friction rubs. Therefore, it was reasonable to perform OT 2 as planned in the DeSScipher project.

Poster publication

Poster publications

Full-text publication

Full-text publications

A full-text paper has been submitted to Rheumatology and is currently under revision.