Evaluating processes underlying the predictive value of baseline erosions for future radiological damage in early rheumatoid arthritis.
Ann Rheum Dis
; 74(5): 883-9, 2015 May.
Article
em En
| MEDLINE
| ID: mdl-24431393
ABSTRACT
OBJECTIVES:
Baseline erosions are characteristic for rheumatoid arthritis (RA) and predictive for a severe disease course. The mechanisms leading to baseline erosions being a strong predictor for radiological progression are unknown. We aimed to increase this understanding by mediation analyses in an observational cohort and a cross-sectional MRI study.METHODS:
3256 hands and feet radiographs of 653 early RA patients assessed during 7 years of disease were scored using the Sharp-van der Heijde method. Mediation models and multivariate regression analyses were used to explore the association between baseline erosions, other predictors and radiological damage over time. 603 joints (MCP2-5 and MTP1-5) of 67 RA patients underwent 1.5â T MRI at baseline. Data on MRI inflammation were compared with clinical inflammation and baseline radiological erosions.RESULTS:
Patients with baseline erosions had, at any point in time during 7 years, 3.45 times more joint damage than patients without erosions (p<0.001, 95% CI 3.00 to 3.98). Baseline erosions were an independent predictor and not a mediator between symptom duration, systemic or local clinical inflammation (erythrocyte sedimentation rate (ESR), swollen joint count (SJC)) or autoantibodies (anti-citrullinated-peptide antibodies, rheumatoid factor) and radiological damage. Subclinical MRI inflammation was studied in relation to erosions, revealing that 83% of the non-swollen joints with baseline erosions had subclinical MRI inflammation compared with 25% of the non-swollen joints without baseline erosions (OR 15.2 95% CI 3.1 to 102.1). The association between MRI inflammation and baseline erosions was independent of symptom duration, ESR, SJC and autoantibodies.CONCLUSIONS:
Baseline erosions are a predictor for future joint damage, independent of known predictors as time, autoantibodies or clinical measurable inflammation. Subclinical inflammation is suggested as an underlying mechanism.Palavras-chave
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MEDLINE
Assunto principal:
Artrite Reumatoide
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Articulações do Pé
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Articulação da Mão
Idioma:
En
Ano de publicação:
2015
Tipo de documento:
Article