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.
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.
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.
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.
"Physical examination per se is thus expected to provide important information on different radiological outcomes of the disease. Accordingly, cumulative swollen joint counts (SJCs) have repeatedly been shown to be associated with joint damage progression over time at both the patient and the individual joint level [Van Leeuwen et al. 1994; Smolen et al. 2006; Boers et al. 2001; Klarenbeek et al. 2010]. A proof of concept of the tight relationship between clinically active joints and structural changes is provided by the demonstration that repair (the opposite of progression), although it remains an extremely rare feature in RA [van der Linden et al. 2010], may only occur in association with improvement or cessation of clinical swelling [Lukas et al. 2010]. "
[Show abstract][Hide abstract] ABSTRACT: Although rheumatoid arthritis (RA) is traditionally considered as the prototype of destructive arthritis, the course of the disease varies considerably, with some patients experiencing more rapid progression of joint damage and disability than others. Given the increasing availability of treatment targets and options, timely recognition of individual's outcomes could allow therapeutic allocation according to personalized benefit-risk profiles. Research efforts are thus increasingly focused at discovering predictive markers that could identify patients with aggressive, rapidly progressive disease and poor prognosis. As joint destruction in RA is the result of the cumulative burden of inflammation, variables reflecting the severity of synovitis and its persistence over time might refine our ability to build early prognostic algorithms. The goal of this article is to review the clinical implications of the assessment of synovitis in relation to radiographic outcomes. Traditional and novel assessment tools will be discussed, including clinical measures, imaging techniques and tissue biomarkers. Achievements in the field of synovial tissue analysis and peripheral blood biomarkers of synovitis represent only the first steps of ongoing progress, which still need to be integrated into the phenotypic heterogeneity of RA.
Therapeutic advances in musculoskeletal disease 08/2012; 4(4):235-44. DOI:10.1177/1759720X12453092
[Show abstract][Hide abstract] ABSTRACT: The approach to treating rheumatoid arthritis has changed over the last decade not only because of new therapeutic agents but also because of new treatment strategies. These strategies involve aiming at a treatment target, usually remission or low disease activity and monitoring patients regularly to attain this goal. Here we review the most recent insights related to monitoring of rheumatoid arthritis.
New insights were gained into the advantages and limitations of patient global assessment of disease severity and self-reported joint counts. The stringency of defining remission by the simplified disease activity index when compared with other instruments was confirmed by ultrasonography. Sensitivity to change and similarity to clinical assessments were shown for ultrasonographic indices; a simplified score for assessing joint damage by magnetic resonance imaging was presented. Physical function and working capacity continue to be impaired in the most recent decade. The evidence-based treat-to-target recommendations, developed by an international task force, are means to improve this situation. The American College of Rheumatology and the European League Against Rheumatism have most recently developed a stringent definition of remission for trials and practice.
The recent data provide compelling evidence for the importance of monitoring to attain the treatment targets in rheumatoid arthritis.
Current opinion in rheumatology 03/2011; 23(3):252-8. DOI:10.1097/BOR.0b013e328345743a · 4.89 Impact Factor
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