Erosions develop rarely in joints without clinically detectable inflammation in patients with early RA

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J Rheumatol. 2003 Dec; 30(12): 2580-4.

Erosions develop rarely in joints without clinically detectable

inflammation in patients with early rheumatoid arthritis.

Sokka T, Kautiainen H, Mottonen T, Hannonen P.

Jyvaskyla Central Hospital, Jyvaskyla, Finland.

tuulikki.sokka@...

OBJECTIVE: To study whether clinically observed tenderness and/or

swelling of a wrist joint over the first 3 years after diagnosis predict

the development of erosions in radiographs of the same joint at 5 years

in patients with early rheumatoid arthritis (RA). METHODS: A total of 58

patients with recent onset RA were enrolled in a prospective RA study at

Jyvaskyla Central Hospital in 1983-85. Physical examination including

joint counts was performed 6 times over 3 years (at 0, 6, 12, 18, 24,

and 36 mo). Radiographs of hands and feet taken at the 5-year visit were

scored according to the Larsen method (0-1 = non-erosive; 2-5 =

erosive). At each visit, the wrist joints were assessed for tenderness

(0/1) and swelling (0/1). A frequency (ranging from 0 to 6) was

calculated for 4 inflammation categories tenderness, swelling,

tenderness or swelling, and tenderness and swelling over the 3 years.

Percentages of wrist joints with erosions on the 5-year radiographs were

calculated for the frequency groups 0, 1, 2-3, and 4-6 of each category.

Two patients died, and 5 wrists were erosive at baseline. Thus the data

for 107 wrist joints of 54 patients were available for analyses.

RESULTS: A statistically significant correlation was seen in the

frequency of clinical inflammation and the development of erosions. Only

one (3.3%) wrist with no tenderness in 6 examinations over the first 3

years developed erosions over 5 years, while 13 (59.1%) wrists that were

tender 4-6 times in 6 examinations developed erosions. The corresponding

percentages were 4.4% and 50.0% for wrists with swelling, 3.4% and 51.6%

for wrists with tenderness or swelling, and 6.1% and 75.0% for wrists

with tenderness and swelling.

CONCLUSION: Radiographic erosions develop rarely without preceding

clinically detectable inflammation in the joints of patients with early

RA.

PMID: 14719197

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