Prognostic factors for joint destruction in RA: a prospective longitudinal study of 318 patients

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J Rheumatol. 2003 Dec; 30(12): 2585-9.

Prognostic factors for joint destruction in rheumatoid arthritis: a

prospective longitudinal study of 318 patients.

Guillemin F, Gerard N, van Leeuwen M, Smedstad LM, Kvien TK, van den

Heuvel W; EURIDISS Group.

School of Public Health EA 3444, Faculty of Medicine, 9 avenue de la

Foret de Haye, BP 184, 54505 Vandoeuvre-les- Cedex, France.

francis.guillemin@...

OBJECTIVE: To quantify articular damage and to investigate prognostic

factors for joint damage progression in rheumatoid arthritis (RA).

METHODS: RA patients satisfying the 1987 American College of

Rheumatology criteria and with disease duration under 5 years were

sampled from the EURIDISS longitudinal cohort study in Norway, The

Netherlands, and France. Hand radiographs were assessed at baseline and

at 2 to 3 year followup using Sharp score modified by van der Heijde.

Assessment of erosion and joint space narrowing, performed in sequential

order by a single reader blinded to patients' characteristics, had high

intraobserver reproducibility (intraclass correlation coefficient

0.98-0.99). Baseline prognostic factors were analyzed in a multivariate

linear regression model. RESULTS: A total of 318 patients with RA aged

52.4 years (70.4% were female) and with a mean 2 years' disease duration

at baseline were followed over 30 months. Median (quartiles) baseline

and followup modified Sharp scores were 3 (0-11) and 9 (1-27),

respectively, with 35.8% and then 22.3% of patients with no radiological

damage. Controlling for age, sex, and country, the final joint damage

was predicted by baseline modified Sharp score, rheumatoid factor

positivity, time from disease diagnosis, patient global health

assessment, and erythrocyte sedimentation rate, and by followup

duration, explaining 76.8% of the outcome variance.

CONCLUSION: This multinational study confirmed the prognostic role in RA

of a set of features previously identified in smaller cohorts. It

indicates which disease characteristics should be focused on in the

early years of RA to identify patients at higher risk of developing

severe disease and who are candidates for aggressive therapy.

PMID: 14719198

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