Radiographic progression is getting milder in patients with early RA. Results of 3 cohorts over 5 years.

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J Rheumatol. 2004 Jun;31(6):1073-82.

Radiographic progression is getting milder in patients with early

rheumatoid arthritis. Results of 3 cohorts over 5 years.

Sokka T, Kautiainen H, Hakkinen A, Hannonen P.

Jyvaskyla Central Hospital, Jyvaskyla, Finland.

OBJECTIVE: There is a common impression, rarely documented, that the

outlook of patients with rheumatoid arthritis (RA) is different today

compared to previous decades. We investigated the 5-year radiographic

progression of 3 cohorts of patients with early RA enrolled in the 1980s

and 1990s. METHODS: Patients with early RA were enrolled into 3 separate

studies in 1983-85 (n = 58; Cohort A), 1988-89 (n = 77; Cohort , and

1995-96 (n = 62; Cohort C) at one rheumatology center; all were

subsequently treated actively with disease-modifying antirheumatic drugs

according to the " sawtooth strategy " to control inflammation, and

monitored regularly to collect data for evaluation of longterm outcome.

Evaluation over 5 years included disease activity measures and

medications. Radiographs of hands and feet taken at baseline and at 2

and 5 years were analyzed by Larsen score (0-100). RESULTS: Larsen score

increased by a median of 12, 6, and 4 points by Year 5 in cohorts A, B,

and C, respectively (p = 0.001), adjusted for age, sex, rheumatoid

factor (+/-), and the baseline values for Larsen score and erythrocyte

sedimentation rate. RF positivity and persistent high disease activity

over 5 years were associated with greater progression of radiographic

damage.

CONCLUSION: Radiographic progression was greatest in the earliest cohort

and mildest in the most recent cohort, a phenomenon that was also seen

in the literature review. The reasons for the observation may include

(1) improved therapy, (2) milder disease, and (3) patient selection.

PMID: 15170917

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