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Rapid radiological progression in the first year of early rheumatoid arthritis is predictive of disability and joint damage progression during 8 years of follow-up
  1. M van den Broek1,
  2. L Dirven1,
  3. J K de Vries-Bouwstra1,
  4. A J Dehpoor1,
  5. Y P M Goekoop-Ruiterman2,
  6. A H Gerards3,
  7. P J S M Kerstens4,
  8. T W J Huizinga1,
  9. WF Lems5,
  10. C F Allaart1
  1. 1Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Department of Rheumatology, HAGA Hospital, The Hague, The Netherlands
  3. 3Department of Rheumatology, Vlietland Hospital, Schiedam, The Netherlands
  4. 4Department of Rheumatology, Jan van Breemen Research Institute Reade, Amsterdam, The Netherlands
  5. 5Department of Rheumatology, VU Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Marianne van den Broek, Department of Rheumatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands; m.van_den_broek{at}


Objective Several prediction models for rapid radiological progression (RRP) in the first year of rheumatoid arthritis have been designed to aid rheumatologists in their choice of initial treatment. The association was assessed between RRP and disability and joint damage progression in 8 years.

Methods Patients from the BeSt cohort were used. RRP was defined as an increase of ≥5 points in the Sharp/van der Heijde score (SHS) in year 1. Functional ability over 8 years, measured with the health assessment questionnaire (HAQ), was compared for patients with and without RRP using linear mixed models. Joint damage progression from years 1 to 8 was compared using logistic regression analyses.

Results RRP was observed in 102/465 patients. Over 8 years, patients with RRP had worse functional ability: difference in HAQ score 0.21 (0.14 after adjustment for disease activity score (over time)). RRP was associated with joint damage progression ≥25 points in SHS in years 1–8: OR 4.6.

Conclusion RRP in year 1 is a predictor of worse functional ability over 8 years, independent of baseline joint damage and disease activity. Patients with RRP have more joint damage progression in subsequent years. RRP is thus a relevant outcome on which to base the initial treatment decision.

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  • Funding The study was designed by the investigators and supported by a government grant from the Dutch College of Health Insurance Companies, with additional funding from Janssen BV and Schering-Plough.

  • Competing interests None.

  • Ethics approval This study was approved by the medical ethics committees of all participating centers.

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

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