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In rheumatoid arthritis (RA) inflammation causes joint destruction,1–3 but disconnection between inflammation and destruction has also been described.4–10 Although several studies have evaluated the relation between inflammation and destruction, it has never been quantified to what proportion the variance in joint destruction is accounted for by cumulative doses of inflammation. Therefore, we evaluated the variance in severity of joint destruction on hands and feet radiographs after 5 years of disease (Sharp-van-der-Heijde method, SHS) that is contributed by a cumulative dose of inflammation over this period. Ethical approval was obtained from the local ethical committee and all included patients gave their informed consent.
The cumulative inflammatory burden was estimated using the area under the curve of 3-monthly measured C reactive protein levels (AUCCRP). First, 278 RA patients (1987 ACR criteria) with 2692 CRP measurements and with radiographs at 5-year follow-up of the Leiden Early-Arthritis-Clinic10 were studied. Second, 911 CRP measurements obtained from 74 Groningen11 RA patients with radiographs at 4, 5, 6 or 7 years follow-up (depending on the availability of the radiographs) were studied as replication cohort. This study period was chosen since a substantial number of Groningen patients had no radiograph exactly …