Objective. To determine the incidence of radiographic knee osteoarthritis (OA) and symptomatic OA (symptoms plus radiographic OA), as well as the rate of progression of preexisting radiographic OA in a population-based sample of elderly persons.Methods. Framingham Osteoarthritis Study subjects who had knee radiographs and had answered questions about knee symptoms in 1983-1985 were reexamined in 1992-1993 (mean 8. l-year interval) using the same protocol. Subjects were defined as having new (incident) radiographic OA if they developed grade 2 2 OA (at least definite osteophytes or definite joint space narrowing). New symptomatic OA was present if subjects developed a combination of knee symptoms and grade 2 2 OA. Progressive OA was diagnosed when radiographs showing grade 2 disease at baseline showed grade 2 3 disease on followup.Results. progressive disease occurred slightly more often in women (relative risk = 1.4; 95% CI 0.8-2.5) but rates did not vary by age in this sample. Among women, approximately 2 % per year developed incident radiographic disease, 1 % per year developed symptomatic knee OA, and about 4% per year experienced progressive knee OA.Conchsion. In elderly persons, the new onset of knee OA is frequent and is more common in women than men. However, among the elderly, age may not affect new disease occurrence or progression.Symptomatic knee osteoarthritis (OA) affects -6% of the adult population and occurs in almost 10% of those over age 65 (1). It accounts for the majority of total knee replacements in the United States, and recent evidence suggests that it accounts for as much lower extremity physical disability in the elderly as any other disease (2). For a disease so common and with such an enormous impact on affected persons and on society, remarkably little is known about its incidence and progression in the population. While the prevalence of knee OA has now been studied, the development of OA over time and the rate of progression of both radiographic and symptomatic disease are poorly characterized. Evaluations of etiologic factors, secular trends in disease, and comparisons of disease rates across populations are best performed with information on the rate of incident or new disease.There has been only one population-based incidence study of knee OA that incorporated serial radiographs of the knees and questions about symptoms. This important 12-year followup study of subjects from Holland (3) evaluated only 258 subjects and found low incidence rates.Studies of disease progression have been more

Objective. Knee osteoarthritis (OA) is highly prevalent, especially in the elderly. Preventive strategies require a knowledge of risk factors that precede disease onset. The present study was conducted to determine the longitudinal risk factors for knee OA in an elderly population.Methods. A longitudinal study of knee OA involving members of the Framingham Study cohort was performed. Weight-bearing knee radiographs were obtained in 1983-1985 (baseline) index increased the risk of OA (OR = 1.6 per 5-unit increase, 95% CI 1.2-2.2), and weight change was directly correlated with the risk of OA (OR = 1.4 per 10-lb change in weight, 95% CI 1.1-1.8). Physical activity increased the risk of OA (for those in the highest quartile, OR = 3.3, 95% CI 1.4-7.5). Smokers had a lower risk than did nonsmokers (for those who smoked an average of 1 1 0 cigarettedday, OR = 0.4, 95% CI 0.2-0.8). Factors not associated with the risk of OA included chondrocalcinosis and a history of hand OA. Weight-related factors affected the risk of OA only in women.Conclusion. Elderly persons at high risk of developing radiographic knee OA included obese persons, nonsmokers, and those who were physically active. The direction of weight change correlated directly with the risk of developing OA.Osteoarthritis (OA) is the most common joint disease, especially in the elderly. However, partly because of the slow time course of disease development, no substantial longitudinal studies of risk factors for the disease have been performed. Knowledge of the risk factors for knee OA has been derived from crosssectional studies.Similar to many chronic diseases, the pathogenesis of OA is likely to be multifactorial. Risk factors consistently associated with the disease in cross-sectional studies include older age, female sex, and being overweight (1). In cross-sectional studies, the OA could develop first, leading a person to become sedentary and to gain weight. We have reported that higher weight in early life predisposes patients to knee OA (2), and that weight loss lowers the risk of developing symptomatic knee OA (3). Both results were based on a one-time assessment of OA occurrence (3). We (4) and others ( 5 )

Introduction Ankylosing spondylitis (AS) is a chronic rheumatic disease associated with spinal inflammation that subsequently leads to progression of structural damage and loss of function. The fully human anti-tumor necrosis factor (anti-TNF) antibody adalimumab reduces the signs and symptoms and improves overall quality of life in patients with active AS; these benefits have been maintained through 2 years of treatment. Our objective was to compare the progression of structural damage in the spine in patients with AS treated with adalimumab for up to 2 years versus patients who had not received TNF antagonist therapy.

Numerous methods for reading abnormalities of rheumatoid arthritis in hand and wrist radiographs have been proposed over the past several decades. There are many differences among these methods, one of the more striking of which is the variation in the number of joints that are scored. In this study, we tested the number of joints that need to be read in order to represent abnormalities accurately and reproducibly, using the scores of multiple observers. Thirteen rheumatologists and radiologists each read a set of 41Presented at a workshop sponsored by the Joe and Betty Alpert Arthritis Center, Rose Medical Center, Denver, CO, November [28][29] 1983.Supported by a grant from the Eli LiHy Company, Indianapolis, IN.John T. Sharp hand and wrist films from patients with rheumatoid arthritis. Ten of 13 readers scored 27 joints in each hand and wrist; the other 3 readers scored fewer areas. Fourteen combinations of joints were selected based on the frequency of involvement and the technical adequacy of routine films in assessing a given area. After testing these 14 different combinations, 1 scheme, which included 17 areas read for erosions and 18 areas read for joint space narrowing, was tested further. The correlation coefficients for 10 intraobserver scores derived from this modified scheme compared with the original scores were between 0.981 and 0.997. Seventy-one of 78 interobserver comparisons were better using the new scheme than using the original scheme. These data indicate that the simplified scheme, using a combination of 17 joints to score erosions and 18 to score joint space narrowing, more accurately reflects the extent of abnormalities perceived by a panel of experts than does the original scheme. This abbreviated number of joints shortens the amount of time required to read a set of films and simplifies the scoring of films, since a number of areas that are difficult to read are eliminated from radiographic assessment.Destruction of bone and cartilage is a regular consequence of persistent, active synovitis in patients with rheumatoid arthritis (RA). Because finger and wrist joints are frequently involved in this disease, a number of investigators over the past several decades have proposed that an assessment of the severity of erosions and cartilage loss in hand and wrist joints, logically, would represent an index of the outcome of this disease process (1-6). More recently, it has been proposed that individual joints should be scored separately and the scores summed in order to accurately

Objective. To determine the long-term efficacy and safety of low-dose methotrexate (MTX) in rheumatoid arthritis (RA).Method&. Eighty-four-month open prospective trial at a single academic rheumatology center.Results. Twenty-six patients were enrolled in a prospective study of the long-term efficacy of MTX in RA; a significant improvement had been demonstrated after 36 months of therapy. Twelve patients remained in the study at the 84-month visit; the mean weekly dosage of MTX was 10.2 mg. A significant improvement was still noted at 84 months in the number of painful joints, number of swollen joints, joint pain index, joint swelling index, and physician and patient global assessments. A 50% improvement in the joint pain index and joint swelling index was observed in more than 80% of the 12

The clinical and radiographic findings of 194 patients with rheumatoid arthritis and atlantoaxial (C1-C2) subluxation and/or atlantoaxial impaction (AAI) were reviewed. The condition of most patients with C1-C2 alignment abnormalities remained unchanged or became worse with time (i.e., the misalignment became fixed, subluxation increased, or AAI developed). The chance of developing upper cervical cord compression was not related to worsening per se, but to the degree of deformity. Upper spinal cord compression developed more often in men; when C1-C2 subluxation was greater than 9 mm; and in the presence of atlantoaxial impaction. The presence of lateral C1-C2 subluxation probably also contributes to the development of upper spinal cord compression. Settling of the skull and C1 onto C2 (AAI) were considered to be present when the anterior arch of C1 was abnormally low in relation to C2.

This study reports findings on joint fluid enhancement after intravenous administration of gadopentetate dimeglumine. Ten subjects were studied: two asymptomatic volunteers and eight patients with suspected meniscal tears. The subjects underwent imaging at 1.5 T before, immediately after, and 42-60 minutes after intravenous administration of gadopentetate dimeglumine. The rate of fluid enhancement was assessed in three subjects, and the effects of exercise were studied. All subjects exhibited enhancement of joint fluid. Mean fluid enhancement for patients was 137% on initial and 262% on delayed images obtained after exercise. Exercise increased the rate and degree of fluid enhancement and distributed contrast material uniformly throughout the joint. The arthrographic effect of the fluid enhancement increased the number of perceived cartilage defects. This study documents enhancement of joint fluid in healthy subjects and in those with effusions. The arthrographic effect may provide a more convenient alternative to intraarticular injection of gadopentetate dimeglumine for MR arthrography.

Twenty-six patients with severe rheumatoid arthritis who had completed a randomized crossover trial of methotrexate elected to continue to receive the drug in a long-term prospective study. At 36 months, 16 patients remained in the study. Over this period of time, significant improvement was noted in the number of painful and swollen joints, physician and patient global assessments, erythrocyte sedimentation rate, and prednisone dose. Adverse reactions occurred in 16 patients (62%), including nausea, alopecia, headache, stomatitis, herpes zoster, and diarrhea. Mild leukopenia (3 patients), thrombocytopenia (3 patients), and elevated transaminase levels (8 patients) resolved with temporary drug discontinuation. No patient withdrew due to drug toxicity. Liver biopsy specimens in 17 patients after 24 months of treatment showed no evidence of fibrosis or cirrhosis. A significant increase in the percentage of T3 and T4 blood cells and increases in lymphocyte proliferation to concanavalin A and purified protein derivative of tuberculin were found after 2 years of therapy. Our findings PATIENTS AND METHODSPatients. Twenty-eight patients with classic or definite RA (12) who had completed a randomized, crossover trial comparing MTX with placebo were eligible to enroll in a long-term open study of MTX. Each patient remained under the care of his or her personal rheumatologist during the study, was advised to abstain from alcohol, and continued to receive, if needed, aspirin or another nonsteroidal antiinflammatory drug (NSAID). Those patients who were receiving prednisone at entry to the randomized crossover trial were maintained at a dosage not exceeding 10 mg/day; adjustment of the prednisone dosage was allowed during the open study.Methotrexate tablets (2.5 mg) were ingested at 8 AM, 8 PM, and 8 AM, beginning on the same day, once a week. Adjustments in the MTX dosage were allowed during the open study. The maximum dose was 15 mg/week. Informed consent was obtained every 12 months during the open study.Clinical assessments. Clinical evaluations were performed by the same physician investigator every 2 months for the first 2 years of the study and every 6 months thereafter. The clinical disease variables determined at each visit were as follows: 1) of 66 diarthrodial joints, the number with swelling; 2) of 68joints, the number with tenderness on