Radiographic Progression Is Getting Milder in Patients with Early Rheumatoid Arthritis. Results of 3 Cohorts Over 5 Years

TUULIKKI SOKKA, HANNU KAUTIAINEN, ARJA HÄKKINEN, and PEKKA HANNONEN

ABSTRACT.

Objective. There is a common impression, rarely documented, that the outlook of patients with rheumatoid arthritis (RA) is different today compared to previous decades. We investigated the 5-year radiographic progression of 3 cohorts of patients with early RA enrolled in the 1980s and 1990s.

Methods. Patients with early RA were enrolled into 3 separate studies in 1983-85 (n = 58; Cohort A), 1988-89 (n = 77; Cohort B), and 1995-96 (n = 62; Cohort C) at one rheumatology center; all were subsequently treated actively with disease-modifying antirheumatic drugs according to the "sawtooth strategy" to control inflammation, and monitored regularly to collect data for evaluation of longterm outcome. Evaluation over 5 years included disease activity measures and medications. Radiographs of hands and feet taken at baseline and at 2 and 5 years were analyzed by Larsen score (0–100).

Results. Larsen score increased by a median of 12, 6, and 4 points by Year 5 in cohorts A, B, and C, respectively (p = 0.001), adjusted for age, sex, rheumatoid factor (+/–), and the baseline values for Larsen score and erythrocyte sedimentation rate. RF positivity and persistent high disease activity over 5 years were associated with greater progression of radiographic damage.

Conclusion. Radiographic progression was greatest in the earliest cohort and mildest in the most recent cohort, a phenomenon that was also seen in the literature review. The reasons for the observation may include (1) improved therapy, (2) milder disease, and (3) patient selection. (J Rheumatol 2004;31:1073-82)

Key Indexing Terms:

RHEUMATOID ARTHRITIS
LARSEN SCORE
RADIOGRAPHS
EROSIONS
LONGTERM OUTCOMES
LONGITUDINAL OBSERVATIONAL STUDY

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From Jyväskylä Central Hospital, Jyväskylä, Finland; the Department of Rheumatology, Vanderbilt University, Nashville, Tennessee, USA; and the Rheumatism Foundation Hospital, Heinola, Finland.

Supported in part by a grant from the Academy of Finland and Muikkusäätiö.

T. Sokka, MD, PhD, Vanderbilt University and Jyväskylä Central Hospital; H. Kautiainen, BA, Rheumatism Foundation Hospital; A. Häkkinen, PhD; P. Hannonen, MD, PhD, Jyväskylä Central Hospital.

Address reprint requests to Dr. T. Sokka, Department of Rheumatology, Vanderbilt University, 203 Oxford House, Box 5, Nashville, TN 37232-4500. E-mail: tuulikki.sokka@vanderbilt.edu

Submitted September 3, 2003; revision accepted December 2, 2003.

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