Radiographic changes in rheumatoid arthritis patients attaining different disease activity states with methotrexate monotherapy and infliximab plus methotrexate: the impacts of remission and tumour necrosis factor blockade

Objective: To examine the association of radiographic progression and disease activity states in patients with rheumatoid arthritis (RA) treated with methotrexate with or without infliximab. Methods: Patients (n=1049) with active RA for ≤T3 years and no prior methotrexate treatment were randomly assigned (4:5:5) to receive methotrexate plus placebo or methotrexate plus infliximab 3 or 6 mg/kg at weeks 0, 2, and 6, and every 8 weeks thereafter through week 46. Disease activity was classified by the simplified disease activity index (SDAI) score as remission (≤3.3), low (>3.3 to ≤T11), moderate (>11 to „T26), high (>26). Radiographic progression was measured as change from baseline to week 54 in total Sharp score (TSS). Results: At weeks 14 and 54, more patients receiving methotrexate plus infliximab than methotrexate plus placebo were in remission (10.7% vs. 2.8% week 14; 21.3% vs. 12.3% week 54; p Conclusion: With methotrexate, joint damage progresses even at low and moderate disease activity levels, while methotrexate plus infliximab inhibits radiographic progression across all disease activity states.