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Radiological progression in established rheumatoid arthritis
1Department of Rheumatology, Guy's, King's, and St. Thomas' School of Medicine, King's College Hospital (Dulwich), East Dulwich Grove, London, England. david.l.scott@kcl.ac.uk
The Journal of Rheumatology. Supplement
|April 1, 2004
Summary
Radiographic progression in rheumatoid arthritis (RA) causes significant joint damage over time, with wrists most affected. Rheumatoid factor (RF) positivity and high C-reactive protein (CRP) levels predict faster progression.
Area of Science:
- Rheumatology
- Radiology
- Clinical Medicine
Background:
- Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by joint inflammation.
- Radiographic progression serves as an objective measure of anatomical damage and disease course in RA.
- Understanding progression rates and predictive factors is crucial for effective long-term treatment strategies.
Purpose of the Study:
- To define the rate of joint damage in rheumatoid arthritis.
- To analyze progression in individual joints.
- To identify predictive factors for radiographic progression in RA.
Main Methods:
- Review of six longitudinal prospective studies with 103-378 RA patients followed for up to 20 years.
- Analysis of five prospective studies (40-147 cases) of early RA patients (within 12 months of onset).
- Examination of radiographic data, rheumatoid factor (RF) status, and C-reactive protein (CRP) levels.
Main Results:
- RA patients experienced significant radiographic damage, increasing from <3% initially to over 40% by 20 years.
- Progression rates increased from 1.6% to 2.0% annually.
- 60-73% of early RA cases developed erosions, with wrists showing the most severe damage.
- Rheumatoid factor (RF) positivity and elevated C-reactive protein (CRP) levels were key predictors of radiographic progression.
Conclusions:
- Radiographic progression in RA leads to substantial joint damage over time, particularly in the wrists.
- Rheumatoid factor (RF) positivity is a dominant predictor of erosive damage.
- Monitoring disease activity via CRP levels and considering new markers like anti-CCP may help identify high-risk patients needing suppressive therapy.