PREDICTION OF ARTICULAR DESTRUCTION IN RHEUMATOID-ARTHRITIS - DISEASE-ACTIVITY MARKERS REVISITED

Objective, To assess the predictive value for joint damage progression of commonly used disease activity or process measures in rheumatoid a rthritis (RA). Methods. Seventy-two patients fulfilling the American R heumatism Association criteria for RA were assessed twice yearly for 2 years. Primary outcome variables were progression of articular destru ction, evaluated by Sharp's method, for 6, 12, 18, and 24 month period s. Results, Regression analysis, using random effects linear models, s howed that only C-reactive protein, alpha(1)-acid glycoprotein, iron, and erythrocyte sedimentation rate were significantly, but not indepen dently, associated with 6 month radiographic progression. Traditional clinical measures were not predictive. No assessed marker was able to predict longer term outcome (12 or 18 month joint damage progression). Recent onset disease and older age were also associated with more sev ere radiographic progression. Conclusion, The lack of association betw een clinical measures and laboratory markers as predictors of the prog ression of articular destruction is further evidence of the need to re consider processes and outcomes in RA. This study also suggests that c linical measures and laboratory markers probably do not reflect the sa me underlying process, arguing against gathering these measures under the same heading of ''disease activity measures.''