DEVELOPMENT OF RADIOGRAPHIC DAMAGE DURING THE FIRST 5-6 YR OF RHEUMATOID-ARTHRITIS - A PROSPECTIVE FOLLOW-UP-STUDY OF A SWEDISH COHORT

The objective of this study was to describe the development of radiogr aphic damage in patients with RA and to search for predictors of radio graphic progression over 5 yr. One hundred and thirteen patients, 75 f emale and 38 male, mean age 53 yr, with definite RA and mean disease d uration of 11.4 months, were followed prospectively for 5 yr at an out -patient clinic. Radiographs of the hands and feet were performed annu ally, and evaluated according to Larsen. The predictive value of demog raphic, clinical and laboratory variables at study start was evaluated . A stepwise logistic regression model was applied. We found that radi ological joint damage occurred early and was significantly progressive during the 5 study years. The rate of progression was most prominent during the first 2 yr. At study start, 53% of the patients had no dete ctable erosions, but only 11% remained non-erosive. Twenty-six per cen t of the patients with the initial presence of erosions did not progre ss substantially and needed no aggressive therapy. High joint damage p rogression during the first year, female gender and high baseline ESR could predict 57% of the patients with high total radiographic progres sion. Age, disease duration, rheumatoid factor, genetic factors, activ e joint count and the presence of erosions at study start had no predi ctive value.