Abstract
We conducted the present study to determine whether repair of erosions occurs in patients with rheumatoid arthritis (RA) treated with conventional disease-modifying anti-rheumatic drugs (DMARDs) and to compare clinical characteristics between patients exhibiting and not exhibiting erosion repair. We included in the study a total of 122 RA patients who fulfilled the 1987 American College of Rheumatology criteria for RA; all patients had paired sequential radiographs of both hands and wrists showing erosive changes at baseline. Patients were classified into two groups according to the presence of repair of erosions at follow up, namely the 'repair observed' and 'repair not observed' groups. Clinical characteristics, disease activity, radiographic scores and treatment in the two groups were compared. Forty-four repairs were observed in 13 patients (10.7%). Compared with the repair not observed group, the functional class of the patients in the repair observed group was lower at baseline (P < 0.01) and the mean disease activity was lower at follow up (P < 0.005). The changes in radiographic scores per year (total radiographic score and erosion score) were lower (P < 0.05 and P < 0.01, respectively) in the repair observed group. No difference in treatment was observed. Repair of erosions was detected in 10.7% of RA patients treated with conventional DMARDs. Repairs were associated with low functional class at baseline and low disease activity at follow up. These observations support the importance of reduction in disease activity in RA patients. Because repair of erosions was detected in a substantial number of patients, assessment of erosion repair should be incorporated into the radiographic evaluation and scoring of RA.
Highlights
Rheumatoid arthritis (RA) is a chronic, destructive autoimmune inflammatory disorder of unknown aetiology that occurs in about 1% of the adult population [1].The radiograph has evolved into the 'gold standard' for evaluation of rheumatoid arthritis (RA) progression because it best demonstrates the anatomical destruction of joint structures [2]
To examine whether repair of erosions in RA patients treated with conventional disease-modifying anti-rheumatic drugs (DMARDs) can be detected, we examined 122 RA patients with paired sequential radiographs of both hands and wrists
RA patients with paired sequential radiographs of both hands and wrists exhibiting erosive changes at baseline were included in the study
Summary
Rheumatoid arthritis (RA) is a chronic, destructive autoimmune inflammatory disorder of unknown aetiology that occurs in about 1% of the adult population [1].The radiograph has evolved into the 'gold standard' for evaluation of RA progression because it best demonstrates the anatomical destruction of joint structures [2]. Repair of erosions or reparative changes in RA have rarely been reported [3,4,5,6,7,8,9,10]. Radiographs are rarely obtained in patients who appear to be experiencing remission, in whom repair phenomena may be observed. The most commonly used scoring methods, namely those of Sharp and Larsen and their groups, are not designed to describe reparative changes. The Sharp/van der Heijde method includes 16 areas for erosions and 15 for joint space narrowing in each hand. The erosion score per joint can range from 0 to 5. Joint space narrowing is scored with range from 0 to 4. The maximum erosion score of all joints in both hands is 160 and the maximum score for joint space narrowing
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