The course of radiologic damage during the first six years of rheumatoid arthritis

Objective. To describe the radiologic course in a large cohort of patients with early rheumatoid arthritis (RA) and to analyze individual components o f damage. Methods. Five hundred two patients with recent-onset RA (disease duration < 1 year) underwent annual radiologic assessment for a maximum of 6 years in this longitudinal prospective study, The study was designed to investigate the efficacy of 3 different therapeutic strategies. For the assessment of r adiologic damage, radiographs of the hands and feet were scored according t o the modified Sharp/van der Heijde method (SHS; range 0-448). A mean of 2. 9 (range 1-7) radiographs was read per patient. Results. Stable rates of progression of the SHS, erosion score, and narrowi ng score were found over the course of RA: the mean rates were 8.6, 5.4, an d 3.2 modified Sharp units per year, respectively. The rate of progression of newly (not previously) damaged joints declined, and the rate of progress ion of already damaged joints (which became more damaged) increased during followup, leading to an equal contribution to progression of the SHS at 5 y ears. The joints of the feet, especially the fifth metatarsophalangeal join t, generally became eroded earlier and more of them became eroded compared with the joints of the hands. Conclusion. Radiologic damage progresses at a constant rate. In advanced di sease, monitoring the progression of previously existing damage is as impor tant as assessing new abnormalities in previously undamaged joints. Radiogr aphs of the feet should be included in assessments of radiologic damage tha t are used in clinical intervention trials and daily practice.