PROGRESSION AND REPAIR IN RADIOGRAPHS OF HANDS AND FOREFEET IN EARLY RHEUMATOID-ARTHRITIS

Objective. To evaluate radiographs of patients with early rheumatoid a rthritis (RA) for progression and repair. Methods. Radiographs of hand s and forefeet over 3 years were evaluated at 34 joints based on the m odified Larsen-index, the number of joints with erosions, the area of osseous defects including erosions and cysts, the radiologic activity of lesions and - in relation to preceding status - the number of joint s with qualitative radiologic improvement or deterioration, respective ly, not necessarily seen by the other methods. Results. Counting of jo ints with erosions and assessment of the area of osseous defects yield ed the most impressive results for disease progression with the number of eroded joints being the simplest method. Reparative phenomena incl uded recortication, ''filling in'' and diminution in size of erosions and paraarticular cysts, newly developing demarcation of a previously indistinct articular outline, and the increase in trabecular structure in the vicinity of erosions. The evaluation of qualitative changes sh owed reparative phenomena with increasing frequency involving up to 9. 3% of the joints during the 3rd year, compared with 7.1% of the deteri orating joints. Conclusion. Progression in early RA can be quantitated easily by counting joint erosions. This method appears to be more sen sitive than Larsen's approach. Repair can be shown early in the course of the disease (as early as the second 6-month observation period) by assessing both radiologic activity and qualitative changes, which are not necessarily apparent in the foregoing quantitative methods. Repar ative phenomena associated with healing of erosions and cysts can be n oted increasingly during continuous longterm observation. Evaluation f or healing phenomena should be standardized and considered for inclusi on in therapeutic trials of RA.