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Markers of joint destruction: principles, problems, and potential
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Twenty years ago, Verna Wright commented, "clinicians may all too easily spend years writing `doing well' in the notes of patients who become progressively more crippled before their eyes." Thankfully much of this has changed. Clinicians increasingly understand the advantages of early intervention, particularly in inflammatory joint diseases,1 2 and we now have better, more targeted treatments. During this time, however, our methods of objectively assessing and quantifying joint damage have remained largely unchanged. As a result, it is likely that early joint damage in patients goes undetected and untreated.
Although magnetic resonance imaging initially promised much, it has
delivered little outside highly specialised centres, where software,
coils, and scan sequences change with every passing season. The "gold
standard" for assessing joint damage is still the plain radiograph.
This mainly images only the bone and is insensitive to change, with
reliable differences requiring at least 12 months to evolve. The
scoring of
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