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Extended report
Clinical synovitis in a particular joint is associated with progression of erosions and joint space narrowing in that same joint, but not in patients initially treated with infliximab
  1. N B Klarenbeek1,
  2. M Güler-Yüksel1,
  3. D M F M van der Heijde1,
  4. H M J Hulsmans2,
  5. P J S M Kerstens3,
  6. T H E Molenaar4,
  7. P B J de Sonnaville5,
  8. T W J Huizinga1,
  9. B A C Dijkmans3,6,
  10. C F Allaart1
  1. 1Leiden University Medical Center, Leiden, The Netherlands
  2. 2Haga Hospital, The Hague, The Netherlands
  3. 3Jan van Breemen Institute, Amsterdam, The Netherlands
  4. 4Groene Hart Hospital, Gouda, The Netherlands
  5. 5Admiraal de Ruyter Hospital, Goes, The Netherlands
  6. 6VU Medical Center, Amsterdam, The Netherlands
  1. Correspondence to N B Klarenbeek, Department of Rheumatology, C-01-R, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands; n.b.klarenbeek{at}


Objectives To assess the relationship between joint tenderness, swelling and joint damage progression in individual joints and to evaluate the influence of treatment on these relationships.

Methods First-year data of the Behandel Strategieën (BeSt) study were used, in which patients recently diagnosed as having rheumatoid arthritis (RA) were randomly assigned into four different treatment strategies. Baseline and 1-year x-rays of the hands and feet were assessed using the Sharp–van der Heijde score (SHS). With generalised estimating equations, 3-monthly assessments of tender and swollen joints of year 1 were related to erosion progression, joint space narrowing (JSN) progression and total SHS progression at the individual joint level (definition >0.5 SHS units) in year 1, corrected for potential confounders and within-patient correlation for multiple joints per patient.

Results During year 1, 59% of all 13 959 joints analysed were ever tender and 45% ever swollen, 2.1% showed erosion progression, 1.9% JSN progression and 3.6% SHS progression. Swelling and tenderness were both independently associated with erosion and JSN progression with comparable OR, although with higher OR in the hands than in the feet. Local swelling and tenderness were not associated with local damage progression in patients initially treated with infliximab.

Conclusion Clinical signs of synovitis are associated with erosion and JSN progression in individual joints after 1 year in RA. A disconnect between synovitis and joint damage progression was observed at joint level in patients who were treated with methotrexate and infliximab as initial treatment, confirming the disconnect between synovitis and the development of joint damage in tumour necrosis factor blockers seen at patient level.

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  • Funding This study was funded by a grant of the Dutch College of Health Insurances (College Voor Zorgverzekeringen) with additional funding provided by Schering-Plough, B V and Centocor. The authors, not the sponsors, were responsible for the study design, the collection, analyses and interpretation of all data, the writing of this article and the decision to publish.

  • Competing interests DMFMH, TWJH, BACD and CFA received speakers fees of less than $10 000 per year.

  • Ethics approval This study was conducted with the approval of the medical ethical committees of all participating hospitals.

  • Provenance and peer review Not commissioned; externally peer reviewed.