The progression of erosion and joint space narrowing scores in rheumatoid arthritis during the first twenty-five years of disease

University of Colorado School of Medicine, Denver.
Arthritis & Rheumatology (Impact Factor: 7.76). 07/1991; 34(6):660-8.
Source: PubMed


Erosions and cartilage destruction are nearly universal features in peripheral joints that have been chronically affected by rheumatoid arthritis. Scoring methods to measure the extent of these abnormalities in hands and wrists have been developed and have been thoroughly tested in several studies to establish their reproducibility. In this study, we utilized one of these scoring methods to examine the progression of radiologic damage as related to duration of disease. Two hundred ninety-two patients from 3 different participating centers in the Arthritis, Rheumatism, and Aging Medical Information System were included. Six hundred fifty films of the hands and wrists, obtained from 210 patients, were scored for erosions and joint space narrowing. The average annual rate of progression of the total radiologic score, which sums erosion and joint space abnormalities and has a maximum possible score of 314, was approximately 4 units per year over the first 25 years after onset; this progression was more rapid in the earlier years of disease and slightly slower in the later years. Data were insufficient to accurately determine the progression rate in disease of more than 25 years duration.

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    • "It has been demonstrated that NO is involved in the pathogenesis of arthritis [21,22]; enhanced TRAP activity of osteoclasts increases bone resorption and contributes to bone loss [23]; and IL-1/TNF-α stimulate chondrocytes to increase production of MMPs and other degradative products [24-26]. These mediators cause bone erosion and cartilage degradation, and result in joint damage in RA [27]. Interventions targeting one or more of these mediators have been reported to reduce inflammation and degree of severity of RA, osteoarthritis and osteoporosis [23-25]; therefore, we tested the therapeutic effect of RIAA in mice with CIA. "
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    ABSTRACT: Rho iso-alpha acids (RIAA) from hops have been shown to have anti-inflammatory properties. To understand the mechanisms, we evaluated the effect of RIAA in cell signaling pathways and inflammatory markers using various in vitro models. We also investigated their therapeutic effect in mice with collagen-induced arthritis. The LPS-stimulated RAW 264.7 macrophages were used to evaluate the effect of RIAA on the NF-kappaB and MAPK signaling pathways; phosphorylation of ERK1/2, p38 and JNK was assessed by western blotting and NF-kappaB binding by electrophoretic mobility shift assays. Effect on the NF-kappaB activity was evaluated by the luciferase reporter assays in LPS-stimulated RAW 264.7 cells. GSK-3alpha/beta kinase activity was measured in cell-free assays. The inhibitory effect of RIAA on inflammatory markers was assessed by measuring nitric oxide in LPS-stimulated RAW 264.7 cells, RANKL-mediated TRAP activity in transformed osteoclasts, and TNF-alpha/IL-1beta-mediated MMP-13 expression in SW1353 cells. Mice with collagen-induced arthritis were fed with RIAA for 2 weeks. Symptoms of joint swelling, arthritic index and joint damage were assessed. RIAA selectively inhibited the NF-kappaB pathway while having no effect on ERK1/2, p38 and JNK phosphorylation in LPS-stimulated RAW 264.7 cells. RIAA also inhibited GSK-3alpha/beta kinase activity and GSK-3beta dependent phosphorylation of beta-catenin in RAW 264.7 cells. In addition, RIAA inhibited NF-kappaB-mediated inflammatory markers in various cell models, including nitric oxide in LPS-stimulated RAW 264.7 cells, RANKL-mediated TRAP activity in transformed osteoclasts, and TNF-alpha/IL-1beta-mediated MMP-13 expression in SW1353 human chondrosarcoma cells. Finally, in a mouse model of collagen-induced arthritis, RIAA ameliorated joint damage as evidenced by significant reduction of the arthritis index and histology score; at 250 mg/kg-body weight, RIAA had efficacy similar to that of 20 mg/kg-body weight of celecoxib. RIAA may have potential as an anti-inflammatory therapeutic.
    Journal of Inflammation 09/2009; 6(1):26. DOI:10.1186/1476-9255-6-26 · 2.02 Impact Factor
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    • "The proportion of patients with no erosion at 10 years was 16.9% in our study compared with 4% in the Lindqvist and colleagues cohort [18]. In our study, joint damage gradually, slightly worsened over the 10-year follow-up, without a higher progression rate during the first years of the disease as shown in previous reports [38,39]. The most likely explanation is the difference in treatments received by patients, because in our study most patients were treated with DMARDs, such as methotrexate, which have demonstrated a structural effect, compared with older studies where patients received other DMARDs, frequently hydroxychloroquine. "
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    ABSTRACT: The objectives of this study were to determine the predictive factors of long-term radiographic outcome of rheumatoid arthritis (RA) and to describe the relationship between joint damage and disability over the course of the disease. A cohort of 191 patients with early RA referred from primary care physicians were prospectively followed for 10 years. To determine the predictive factors of radiographic outcome, univariate analysis of the relationship between baseline values and outcome measures was undertaken using a chi-squared or Fisher's exact test. Stepwise multiple logistic regression was also performed to select independent prognostic factors. From data available for 112 patients, univariate analysis revealed a total Sharp score at 10 years that was significantly correlated with erythrocyte sedimentation rate (ESR), presence and level of IgA rheumatoid factor, presence of an anti-citrullinated protein antibody (ACPA), serum level of matrix metalloproteinase-3 and radiographic score at baseline. Logistic regression identified the baseline erosion score to be the most important baseline parameter as an independent prognostic factor of total radiographic score at 10 years (odds ratio = 5.64; 95% confidence interval = 1.78 to 17.86). After excluding radiographic scores from the entry parameters, the presence of ACPA and ESR were also predictive of the final total Sharp score. The Health Assessment Questionnaire (HAQ) score was strongly correlated with disease activity parameters, such as disease activity score and pain, at baseline and at three, five and 10 years. No correlation was found between total radiographic Sharp score and HAQ score throughout the study. In this prospective study, baseline radiographic score, ESR and ACPA were the best predictive factors of 10-year radiographic outcome in early RA. HAQ disability was associated with disease activity throughout the 10-year follow-up but not with joint damage. This discrepancy with previous reports may be due in part to the early start of therapy with disease-modifying anti-rheumatic drugs.
    Arthritis research & therapy 10/2008; 10(5):R106. DOI:10.1186/ar2498 · 3.75 Impact Factor
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    ABSTRACT: Therapies for rheumatoid arthritis (RA) may be assessed according to relative levels of measures to compare efficacy to another therapy or to a placebo, as in the American College of Rheumatology (ACR) 20%, 50%, or 70% (ACR 20 ACR 50 and ACR 70) responses, or by absolute levels of measures, as in disease activity scores (DAS), ACR criteria for remission, or "target values" of specific measures. Regulatory considerations have emphasized primarily relative comparisons to a placebo or standard therapy, derived in part from the weak efficacy of traditional disease modifying anti-rheumatic drugs (DMARDs). While improvement compared to placebo certainly indicates efficacy, it is of concern that measures of inflammatory activity, such as swollen joints and the erythrocyte sedimentation rate (ESR), may be stable or improved over periods of 5-10 years, while measures of damage, such as joint deformity and radiographic changes, may progress over the same period in the same patients. These findings suggest that improvement at a level of 20% or 50% may deter but not prevent severe long-term outcomes of radiographic progression, functional declines, work disability, and premature mortality, seen in most patients until the middle 1990s. Outcomes appear to be improved at this time, associated with aggressive treatment strategies and more powerful therapies, including biologic agents. In the Finnish Rheumatoid Arthritis Combination Therapy Trial (FinRACo), no patient who was in remission after 6 months was receiving work disability payments 4 1/2 years later, compared to 22% of patients who had ACR 20 or 50 responses and 54% of patients who did not have ACR 20 responses after 6 months who were all receiving work disability payments after 5 years. These findings suggest that absolute targets, including remission, may be realistic contemporary goals, with aggressive treatment strategies and more effective DMARDs and biologic agents.
    Clinical and experimental rheumatology 01/2004; 22(5 Suppl 35):S50-6. · 2.72 Impact Factor
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