Risk factors for radiographic articular destruction of hands and wrists inrheumatoid arthritis

Objective. To carry out a cross sectional case-control study of the risk fa ctors for articular destruction in a large sample of patients with a long h istory of rheumatoid arthritis (RA), presupposing that the variables we mea sured were unrelated to the duration of disease. Methods. Each inpatient with RA admitted to our department from January 1, 1985, to December 31, 1995, underwent standard examination, laboratory test s, and hand roentgenograms. We carried out a radiographic cross sectional s tudy on 287 of them. Radiographic evaluation was performed by the same obse rver (correlation coefficient 0.97) using the modified Sharp method. To inv estigate an association between articular destruction and prognostic variab les, a matched analysis of the case-control data and calculation of the odd s ratio (OR) with 95% confidence intervals (CI) were carried out. For each patient with severe articular destruction. patients hospitalized during the study period with the same disease duration but without severe articular d estruction were included as controls. The sample size was chosen to show an OR > 2 (1 - alpha = 95%; 1 - beta = 80%). Results, The risk of articular joint destruction was higher in women than i n men (OR 2.72, CI 1.17-7.9, p < 0.023), whereas age at onset or the presen ce of HLA-DR4. antiperinuclear factor, or antikeratin antibodies was not su fficiently strongly associated with the process of articular destruction to be considered relevant prognostic markers. Conclusion. We conclude that female sex is significantly associated with a higher risk of articular destruction.