RESEARCH - Correlation of single time-point damage scores with radiographic damage during the first 6 years of RA

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J Rheumatol. 2003 Apr;30(4):705-13. Links

Correlation of single time-point damage scores with observed progression of

radiographic damage during the first 6 years of rheumatoid arthritis

Division of Rheumatology, Department of Medicine, UCLA Medical Center, Los

Angeles, California, USA. hpaulus@...

OBJECTIVE: Aggressive treatment of early rheumatoid arthritis (RA) is

recommended to prevent irreversible joint damage. We evaluated the

usefulness of single time-point joint radiographs for deciding whether early

RA is erosive or nonerosive. METHODS: In an observational study, 179

patients with recent onset of RA symptoms (median 5.1 mo), positive

rheumatoid factor, and active polyarthritis had 2 to 8 radiographic

observations of hands, wrists, and forefeet during 6 to 60 months of

followup. Linear regression lines for all available radiographs were used to

determine progression rates of total Sharp score (TSS), erosion score (ES),

and joint space narrowing score (JSNS) of each patient. RESULTS: Using the

average of 2 readers' scores, intraclass correlation coefficient was 0.97

and smallest detectable difference was 3.07 for ES, 0.93 and 7.52 for JSNS,

and 0.90 and 12.71 for TSS. Mean progression rates per year were 1.20 (ES),

0.67 (JSNS), and 1.85 (TSS). Single time-point radiographs taken within 6

months of symptom onset did not correlate with progression rates (r = 0.01

to 0.07); between 7 and 18 months correlations were weak (r = 0.23 to 0.35),

but were better for ES between 19 and 72 months (r = 0.60 to 0.81). Among 53

patients (31%) with no progression of TSS, only 10 of them had zero scores

at baseline. Among all 630 radiographs with TSS > or = 1, 25% were

associated with progression rates < or = 0. CONCLUSION: Erosion scores of

single radiographic examinations done > 18 months after onset of RA symptoms

correlated with progression rates, but earlier radiographs did not

sufficiently predict erosive or nonerosive status to guide disease modifying

antirheumatic drug treatment decisions.

PMID: 12672187

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