Evaluating various radiographic methods of shoulder joint damage inpatients with rheumatoid arthritis receiving biologicaldisease-modifying antirheumatic drugs

Abstract

Objectives: This study aims to clarify shoulder joint damage in rheumatoid arthritis patients receiving biological disease-modifying antirheumaticdrugs (bDMARDs) and the relationship between joint damage and clinical factors. Patients and methods: In this retrospective study conducted between April 2005 and December 2008, 36 shoulders in 19 patients (2 males,17 females; mean age: 58.9 years; range 42 to 75 years) were evaluated at baseline and two years after the initiation of bDMARD therapy withinfliximab (n=14) or etanercept (n=5). Standard anteroposterior radiographs of the shoulder joints were taken at baseline and two years afterinstitution of biological therapy. Structural damage in the shoulder joints was assessed using the Larsen scoring method, the medial displacementindex (MDI), and the upward migration index (UMI). Results: There was a significant correlation between MDI, UMI, and Larsen grade before biological therapy. Univariate analysis revealed that thedisease activity score 28-count erythrocyte sedimentation rate (ESR) at baseline (odds ratio [OR]: 4.298) was associated with progression of MDI.But multivariate logistic regression revealed that there was no association with the progression of MDI. Univariate analysis revealed that ESR atbaseline (OR: 0.967) and matrix metalloproteinase-3 (MMP-3) at baseline (OR: 0.996) were associated with the progression of UMI. Multivariate logisticregression revealed that MMP-3 at baseline (OR: 0.994) was independently associated with the progression of UMI. Conclusion: Medial displacement index and UMI correlated with the Larsen grade of the shoulder joint strongly and moderately, respectively. Thisstudy suggests that MDI and UMI may help to evaluate radiographic progression of damage in shoulder joints in patients on bDMARDs, which isdifficult to detect using the Larsen grade.