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Radiological damage in patients with rheumatoid arthritis on sustained remission
  1. G Cohen1,
  2. L Gossec2,
  3. M Dougados2,
  4. A Cantagrel3,
  5. P Goupille4,
  6. JP Daures5,
  7. N Rincheval5,
  8. B Combe1
  1. 1Immuno-Rhumatologie, Montpellier I University, Centre Hospitalier Universitaire Lapeyronie, Montpellier, France
  2. 2Department of Rheumatology B, Paris 5 University, Cochin Hospital, Paris, France
  3. 3Service de Rhumatologie, Centre Hospitalier Universitaire Rangueil, Toulouse, France
  4. 4Service de Rhumatologie, Centre Hospitalier Universitaire Tours, Tours, France
  5. 5Laboratoire Biostatistique et Epidémiologie, Institut Universitaire de Recherche Clinique, Montpellier, France
  1. Correspondence to:
    Professor Bernard Combe
    Service d’Immuno-Rhumatologie, Hôpital Lapeyronie, 371 Avenue du doyen Gaston Giraud, 34295 Montpellier Cedex 5, France; b-combe{at}chu-montpellier.fr

Abstract

Objective: To assess the radiological damage progression in patients with recent rheumatoid arthritis in sustained remission.

Methods: A cohort of 191 patients with active early (<1 year) rheumatoid arthritis was prospectively assessed at baseline, 3 and 5 years by the Disease Activity Score (DAS) and the Sharp–van der Heijde Score (SHS) for radiographic damage. Patients in remission (DAS<1.6) at the 3-year and 5-year time points were compared with patients with a persistently active rheumatoid arthritis by Wilcoxon’s signed rank test.

Results: 57 patients died, were lost to follow-up or had incomplete data; 30 (15.7% of those who completed) patients were in remission at 3 and 5 years. The SHS in these two groups was not significantly different at baseline (p = 0.15), but was lower in the remission group at 5 years (p = 0.0047). The median (IQR) radiographic score increased from 0.5 (0–7) at baseline to 2.5 (0–14) after 5 years for the remission group (p = 0.18) and from 2 (0–7) to 13 (3–29) in the group with active rheumatoid arthritis (p<0.001). 5 (16.7%) patients in remission had relevant progression of radiographic damage (ie, progression >4.1 points) and 6 (20%) presented new erosions in a previously unaffected joint between the third and the fifth years.

Conclusion: Patients with early rheumatoid arthritis in sustained remission did not present statistically significant radiographic degradation at the group level; nevertheless, 16.7% of these patients did present degradation. Absence of progression should be part of the remission definition in rheumatoid arthritis.

  • ACR, American College of Rheumatology
  • CRP, C reactive protein
  • DAS, Disease Activity Score
  • DMARDs, disease-modifying antirheumatic drugs
  • ESR, erythrocyte sedimentation rate
  • HAQ, Health Assessment Questionnaire
  • MRI, magnetic resonance imaging

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Footnotes

  • Published Online First 25 August 2006

  • Funding: This study was supported by a grant from the Direction de la Recherche Clinique, Centre Hospitalier Montpellier (France).

  • Competing interests: None declared.

  • Contributors: GC read the x rays, coordinated the statistical analysis and drafted the manuscript. BC, MD, AC and PG included and followed up the patients, and shared the design and coordination of the study. BC conceived the study, participated in its design and coordination, and helped to draft the manuscript. LG participated in conceiving the study and coordinating the statistical analysis, and helped to draft the manuscript. JPD participated in the design of the study and supervised the statistical analysis. NR performed the statistical analysis. All authors read and approved the final manuscript.

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