RADIOGRAPHIC ASSESSMENT OF DISEASE PROGRESSION IN RHEUMATOID-ARTHRITIS PATIENTS ENROLLED IN THE COOPERATIVE SYSTEMATIC STUDIES OF THE RHEUMATIC DISEASES PROGRAM RANDOMIZED CLINICAL-TRIAL OF METHOTREXATE, AURANOFIN, OR A COMBINATION OF THE 2

Objective. To determine the radiographic progression of disease in rhe umatoid arthritis (RA) patients from the Cooperative Systematic Studie s of the Rheumatic Diseases clinical trial of auranofin (AUR) versus m ethotrexate (MTX) versus a combination of the two. Methods. Baseline ( week-0) and study-end (week-48) hand/wrist radiographs in 200 of the 2 11 patients who completed this multicenter trial (95%) were scored bli ndly by 2 readers for the presence of erosions and joint space narrowi ng (JSN). Both intraobserver reliability and interobserver reliability were 0.80 for erosions (P less-than-or-equal-to 0.001); intraobserver reliability and interobserver reliability were both 0.75 for JSN (P l ess-than-or-equal-to 0.001). Results. Worsening erosion and JSN scores occurred in all 3 treatment groups, but the difference from baseline reached significance only in the AUR group. Conclusion. Clinical impro vement has been clearly documented in all 3 treatment groups in this t rial. Radiographic deterioration occurs in RA even when clinical featu res improve, but progression of disease as determined radiographically may be slowed by treatment with MTX.