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Erosions Develop Rarely in Joints Without Clinically Detectable Inflammation in Patients with Early Rheumatoid Arthritis
TUULIKKI SOKKA, HANNU KAUTIAINEN, TIMO MÖTTÖNEN, and PEKKA HANNONEN
ABSTRACT.
Methods. A total of 58 patients with recent onset RA were enrolled in a prospective RA study at Jyväskylä Central Hospital in 1983-85. Physical examination including joint counts was performed 6 times over 3 years (at 0, 6, 12, 18, 24, and 36 mo). Radiographs of hands and feet taken at the 5-year visit were scored according to the Larsen method (0–1 = non-erosive; 2–5 = erosive). At each visit, the wrist joints were assessed for tenderness (0/1) and swelling (0/1). A frequency (ranging from 0 to 6) was calculated for 4 inflammation categories — tenderness, swelling, tenderness or swelling, and tenderness and swelling — over the 3 years. Percentages of wrist joints with erosions on the 5-year radiographs were calculated for the frequency groups 0, 1, 2–3, and 4–6 of each category. Two patients died, and 5 wrists were erosive at baseline. Thus the data for 107 wrist joints of 54 patients were available for analyses. Results. A statistically significant correlation was seen in the frequency of clinical inflammation and the development of erosions. Only one (3.3%) wrist with no tenderness in 6 examinations over the first 3 years developed erosions over 5 years, while 13 (59.1%) wrists that were tender 4–6 times in 6 examinations developed erosions. The corresponding percentages were 4.4% and 50.0% for wrists with swelling, 3.4% and 51.6% for wrists with tenderness or swelling, and 6.1% and 75.0% for wrists with tenderness and swelling. Conclusion. Radiographic erosions develop rarely without preceding clinically detectable inflammation in the joints of patients with early RA. (J Rheumatol 2003;30:2580-4) Key Indexing Terms:
EARLY RHEUMATOID ARTHRITIS
From the Jyväskylä Central Hospital, Jyväskylä; Rheumatism Foundation Hospital, Heinola; and Turku University Central Hospital, Turku, Finland. Supported in part by a grant from the Academy of Finland. T. Sokka, MD, PhD, Jyväskylä Central Hospital and Vanderbilt University, Nashville, TN, USA; H. Kautiainen, BA, Rheumatism Foundation Hospital; T. Möttönen, MD, PhD, Turku University Central Hospital; P. Hannonen, MD, PhD, Jyväskylä Central Hospital. Address reprint requests to Dr. T. Sokka, Division of Rheumatology and Immunology, Vanderbilt University School of Medicine, 203 Oxford House, Box 5, Nashville, TN 37232-4500. E-mail: tuulikki.sokka@vanderbilt.edu Submitted February 14, 2003; revision accepted May 21, 2003. |