A considerable proportion of patients with rheumatoid arthritis (RA) also suffer from hand osteoarthritis (OA). We here assess the association between conventional synthetic (cs) and biological (b) disease-modifying antirheumatic drugs (DMARDs) and radiographic distal interphalangeal-(DIP) OA in patients with RA. Adult RA patients from a longitudinal Swiss registry of rheumatic diseases who had ≥ 2 hand radiographs were included at the first radiograph and followed until the outcome or the last radiograph. Patients were grouped into two cohorts based on whether DIP OA was present or absent at cohort entry (cohorts 1 and 2, respectively). Modified Kellgren-Lawrence scores (KLS) were obtained by evaluating DIP joints for the severity of osteophytes, joint space narrowing, subchondral sclerosis, and erosions. KLS ≥ 2 in ≥ 1 DIP joint indicated incident or existing OA, and increase of ≥ 1 in KLS in ≥ 1 DIP joint indicated progression in existing DIP OA. Time-varying Cox regression and generalized estimating equation (GEE) analyses were performed. We estimated hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CI) of DIP OA incidence (cohort 2), or progression (cohort 1), in bDMARD monotherapy, bDMARD/csDMARD combination therapy, and past or never DMARD use, when compared to csDMARD use. In post hoc analyses, we descriptively and analytically assessed the individual KLS features in cohort 1. Among 2234 RA patients with 5928 radiographs, 1340 patients had DIP OA at baseline (cohort 1). Radiographic progression of DIP OA was characterized by new or progressive osteophyte formation (666, 52.4%), joint space narrowing (379, 27.5%), subchondral sclerosis (238, 17.8%), or erosions (62, 4.3%). bDMARD monotherapy had an increased risk of radiographic DIP OA progression compared to csDMARD monotherapy (adjusted HR 1.34 [95% CI 1.07–1.69]). The risk was not significant in csDMARD/bDMARD combination users (HR 1.12 [95% CI 0.96–1.31]), absent in past DMARD users (HR 0.96 [95% CI 0.66–1.41]), and significantly lower among never DMARD users (HR 0.54 [95% CI 0.33–0.90]). Osteophyte progression (HR 1.74 [95% CI 1.11–2.74]) was the most significantly increased OA feature with bDMARD use compared to csDMARD use. In 894 patients without initial DIP OA (cohort 2), the risk of incident OA did not differ between the treatment groups. The results from GEE analyses corroborated all findings. These real-world RA cohort data indicate that monotherapy with bDMARDs is associated with increased radiographic progression of existing DIP OA, but not with incident DIP OA.

中文翻译：

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生物 DMARD 单药治疗伴随类风湿性关节炎期间发生的远端手骨关节炎的放射学进展增加

相当比例的类风湿性关节炎 (RA) 患者还患有手部骨关节炎 (OA)。我们在此评估了 RA 患者常规合成（cs）和生物（b）改善疾病的抗风湿药（DMARDs）与放射学远端指间（DIP）OA之间的关联。来自瑞士风湿病纵向登记处的成人 RA 患者有 ≥ 2 张手部 X 光片被纳入第一张 X 光片，并随访至结果或最后一张 X 光片。根据队列进入时是否存在 DIP OA，将患者分为两个队列（分别为队列 1 和 2）。通过评估 DIP 关节的骨赘、关节间隙变窄、软骨下硬化和侵蚀的严重程度，获得修正的 Kellgren-Lawrence 评分 (KLS)。≥ 1 个 DIP 关节中 KLS ≥ 2 表明发生或存在 OA，≥ 1 个 DIP 关节中 KLS ≥ 1 表明现有 DIP OA 进展。进行了时变 Cox 回归和广义估计方程 (GEE) 分析。我们在 bDMARD 单药治疗、bDMARD/csDMARD 联合治疗以及过去或与 csDMARD 使用相比，从不使用 DMARD。在事后分析中，我们描述性和分析性地评估了队列 1 中的各个 KLS 特征。在 2234 名 RA 患者的 5928 张 X 光片中，1340 名患者在基线时患有 DIP OA（队列 1）。DIP OA 的放射学进展以新的或进行性骨赘形成 (666, 52.4%)、关节间隙变窄 (379, 27.5%)、软骨下硬化 (238, 17.8%) 或侵蚀 (62, 4.3%)。与 csDMARD 单药治疗相比，bDMARD 单药治疗增加了放射学 DIP OA 进展的风险（调整后的 HR 1.34 [95% CI 1.07–1.69]）。csDMARD/bDMARD 联合使用者的风险不显着（HR 1.12 [95% CI 0.96–1.31]），过去的 DMARD 使用者不存在（HR 0.96 [95% CI 0.66–1.41]），并且在从未使用 DMARD 的使用者中显着降低（ HR 0.54 [95% CI 0.33–0.90])。骨赘进展（HR 1.74 [95% CI 1.11–2.74]）是使用 bDMARD 与使用 csDMARD 相比增加最显着的 OA 特征。在 894 名没有初始 DIP OA 的患者中（队列 2），治疗组之间发生 OA 的风险没有差异。GEE 分析的结果证实了所有发现。