Are conventional radiographs still of value?

To describe the most recent randomized-controlled trials (RCTs) and long-term observational studies (LOS) of RCTs with regard to radiological endpoints, and to interpret the results in the context of methodology.

Many RCTs include radiological endpoints, sometimes as primary endpoints, usually as secondary endpoints. The results of these RCTs prove that radiological assessment can still detect meaningful differences in the progression of structural RA-related damage between treatment arms. In addition, LOS provide the opportunity to investigate if radiological progression is stable over time in patients on treatment. Improvements in the selection of appropriate patients (enrichment) and in the analysis of radiological data allow a more meaningful interpretation of radiological data in RA clinical trials and LOS.

Radiological evaluation in RA clinical trials and observational studies is still valuable. Although subtle progression scores observed in clinical trials have limited direct clinical relevance, radiological treatment effects in trials may reflect subtle differences in clinical efficacy between treatment arms, and radiological progression may be considered a reflection of historic disease activity.