Hand Radiography of 200 Patients with Rheumatoid Arthritis Repeated after an Interval of One Year

Abstract

Hand radiography of 200 patients with rheumatoid arthritis RA was repeated after an interval of 12 months. Twenty joints including ten metacarpophalangeal joints, eight proximal interphalangeal joints and two interphalangeal joints of the thumbs were assessed. The number of joints with erosion was recorded, being referred to as Erosion Score. Additionally, each joint was graded on a zero to five point scale and the gradings of the individual joints were summed to form a score referred to as Damage Score. The progression in these scores during 12 months was recorded. The radiological joint damage was found to develop rapidly during the first years after disease onset and to assume a slow rate of increase after 9 years of the disease. The results imply that the disease duration is a critical feature for therapeutic studies. We suggest that patients with disease duration of less than 36 months only are suitable for therapeutic trials of RA and that the follow-up time should be at least 18 months if radiological assessment is used.

Retardation of joint damage in patients with early rheumatoid arthritis by initial aggressive treatment with disease‐modifying antirheumatic drugs: Five‐year experience from the FIN‐RACo study

“…At 2 years, the proportion of patients whose RA was in remission was significantly higher in the combination group than in the single group (40% [95% confidence interval (95% CI) 29-52] versus 18% [95% CI [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]; P Ͻ 0.009). After 2 years, the frequency of remissions tended to remain higher in the original combination group than in the single group: at 3 years, 29% (95% CI 19-41) versus 21% (95% CI 13-31); at 4 years, 34% (95% CI 23-45) versus 21% (95% CI 13-32); and at 5 years, 28% (95% CI 18-39) versus 22% (95% CI 14-33).…”

“…There was a trend toward an increase in radiologic progression in both the combination group (median change in the Larsen score 14 [95% CI [11][12][13][14][15][16][17][18][19]) and the single group (median change in the Larsen score 20 [95% CI [17][18][19][20][21][22][23][24]), which was significant in both groups (P Ͻ 0.001 versus baseline). The increase in the Larsen score was statistically significantly lower in the patients included in the combination group compared with those in the single group (P ϭ 0.004).…”

“…Development of erosions in RA appears to be most rapid during the first 2-3 years after the diagnosis (20,(23)(24)(25)(26)(27). However, the progression of joint destruction in RA patients is retarded by the use of DMARDs.…”

Slow progression of joint damage in early rheumatoid arthritis treated with cyclosporin a

“…This makes it difficult to keep a large enough number of patients enrolled in a long-term study that is designed to obtain all the information required when using a radiographic end point (21,22). Given that a certain degree of erosion within the first few years of disease is to be expected regardless of the DMARD used (2, [23][24][25][26][27], the option for patients in both study groups to switch therapies in the event of toxicity or inefficacy was intended to keep the largest possible number of patients in the study.…”

“…The within-patient PEJC was taken as the primary efficacy variable for sample size calculation. On the basis of the available information (19,24), the study was sized to reject the null hypothesis for a betweengroup difference in mean ? SD PEJC values of at least 0.6 ?…”