CLINICAL IMPROVEMENT AND RADIOLOGICAL DETERIORATION IN RHEUMATOID-ARTHRITIS - EVIDENCE THAT THE PATHOGENESIS OF SYNOVIAL INFLAMMATION AND ARTICULAR EROSION MAY DIFFER

The contrast between clinical improvement and radiological deteriorati on in rheumatoid arthritis (RA) is striking. We characterized this rel ationship using serial disease activity measures and radiographs of ha nds and feet in 40 RA patients observed over 6 yr. All disease activit y measures improved, including grip strength, Ritchie index (RI), haem oglobin and erythrocyte sedimentation rate (ESR) (all P < 0.0001). In contrast, articular erosion increased (P < 0.0001). Radiological chang e during the study correlated with RI (r = 0.49), haemoglobin (r = -0. 56) and ESR (r = 0.53). Radiological status at review also correlated with these variables (r = 0.36. -0.44 and 0.36, respectively). Articul ar erosion continues in RA despite clinical improvement and is acceler ated in those with evidence oi. continuing synovial inflammation, refl ected in clinical and laboratory measures of disease activity. Since m any therapies in RA suppress inflammation, but not erosion, these find ings suggest that the pathogenesis of articular erosion may differ fro m that of synovial inflammation.