Dramatic Repair of Joint Damage in Psoriatic Arthritis

Abstract

Repair on radiographs of hands and feet is not a new phenomenon. Carefully comparing consecutive sets of radiographs of patients with rheumatoid arthritis (RA) in clinical remission occasionally revealed disappearing erosions over time in the prebiological era1, but repair, or “healing” as it was called in those days, was not systematically evaluated until recently. Nevertheless, there were true believers of healing that rightfully claimed, as do Eder and colleagues in this issue of The Journal in patients with psoriatic arthritis (PsA)2: “We believe what we see.” The methodological interest in repair was fuelled by the advent of phase 3 trials with tumor necrosis factor (TNF) inhibitors. These trials showed for the first time in history not only a near-complete arrest in radiographic progression, but also negative progression scores in a significant proportion of the patients treated with TNF inhibitors. In order to understand these negative scores, it is important to briefly outline how progression scores are generated in clinical trials. Usually, 2 independent readers are presented with consecutive sets of radiographs of hands and feet in order to comparatively score these radiographs on a per-joint basis for erosions and joint space narrowing. Importantly, these readers are not aware of the true time order of the radiographs, so that … Address correspondence to Dr. van der Heijde; E-mail: d.vanderheijde{at}kpnplanet.nl