Course of radiographic damage over 10 years in a cohort with early rheumatoid arthritis

Abstract

Objective: To investigate development of radiographic damage in hands and feet of patients with early rheumatoid arthritis (RA) monitored prospectively for 10 years, and to search for prognostic factors.

Patients and methods: 181 patients with early RA (mean disease duration one year) were assessed annually with radiographs of hands and feet during years 0-5 and at year 10. Radiographs were evaluated according to Larsen (range 0-200). Predictive factors for progressive disease for years 0-5 and 5-10 were evaluated by logistic regression analyses.

Results: 82/168 (49%) patients had erosions at inclusion and almost all became erosive with time (90% after two years and 96% after 10 years). Radiographic progression was most rapid during the first two years and 75% of all damage occurred during the first five years. The median Larsen score increased from 6 at inclusion to 41 after five years and 54 after 10 years. Only 5.3% of all evaluated joints became maximally eroded, the second metacarpophalangeal joint being the most commonly affected. Mean ESR during the first three months and rheumatoid factor status were significant predictors for radiographic progressive disease, it was not possible to predict non-progressive disease.

Conclusions: Joint damage in hands and feet developed early and progression was most rapid during the first years of disease. The different rates of progression at different stages should be considered in the design of trials of drugs aimed at retarding joint damage. Disease activity at study start influenced the degree of joint damage during the entire 10 years.

Figures

Figure 1

The Larsen scores at each year. The box plots show the median and 10th, 25th, 75th, and 90th centiles. All changes in Larsen scores were highly significant (p

Figure 2

Progression rates of radiographic damage for each year during the first five years and from year 5–10. The box plots show the median and 10th, 25th, 75th, and 90th centiles.

Figure 3

Percentage of examined joints with erosive changes (Larsen 2–5).

Figure 4

Number of patients with at least one joint with maximal Larsen score (5).