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Evaluation of the contribution of cumulative levels of inflammation to the variance in joint destruction in rheumatoid arthritis
  1. Rachel Knevel1,
  2. Jessica Annemarie Bernadette van Nies1,
  3. S le Cessie2,
  4. Tom W J Huizinga1,
  5. E Brouwer3,
  6. Annette H M van der Helm-van Mil1
  1. 1Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Departments of Epidemiology, Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
  3. 3Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  1. Correspondence to Dr Rachel Knevel, Department of Rheumatology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333, The Netherlands; r.knevel{at}

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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 …

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  • Contributors All contributors have made substantial contribution to the writing and revision of the manuscript and all agreed on the final version. JABN, RK, AHMHM and EB contributed substantially to the data collection. RK, AHMHM and SC designed the study.

  • Competing interests None.

  • Ethics approval The local ethical committee approved this study.

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