Course of radiographic damage over 10 years in a cohort with early rheumatoid arthritis
Course of radiographic damage over 10 years in a cohort with early rheumatoid arthritis
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DOI：
10.1136/ard.62.7.611
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发表时间：
2003-07-01
影响因子：
27.4
通讯作者：
Eberhardt, K
中科院分区：
文献类型：
--
作者：
Lindqvist, E;Jonsson, K;Eberhardt, K
目的：研究前瞻性监测10年的早期类风湿关节炎(RA)患者手足的X线表现，寻找影响预后的因素。方法：对181例早期类风湿关节炎(RA)患者在0~5年和10年时分别拍摄手足X线片，按Larsen评分标准进行评分。结果：168例患者中有82例(49%)在包裹体处有糜烂，且几乎所有患者都随着时间的推移而发生糜烂(两年后90%，10年后96%)。放射学进展在头两年最快，75%的损伤发生在前五年。拉森评分的中位数从纳入时的6分增加到5年后的41分和10年后的54分。在所有评估的关节中，只有5.3%的关节受到最大程度的侵蚀，第二掌指关节受到的影响最大。前三个月的平均血沉和类风湿因子状态是放射学进展性疾病的显著预测因素，无法预测非进展性疾病。结论：手足关节损伤发展较早，在疾病的第一年进展最快。在设计旨在延缓关节损伤的药物试验时，应考虑不同阶段的不同进展速度。研究开始时的疾病活动影响了整个10年中关节损伤的程度。
Objective: To investigate development of radiographic damage in hands and feet of patients with early rheumatoid arthritis (RA) monitored prospectively for 10 years, and to search for prognostic factors.Patients and methods: 181 patients with early RA (mean disease duration one year) were assessed annually with radiographs of hands and feet during years 0-5 and at year 10. Radiographs were evaluated according to Larsen (range 0-200). Predictive factors for progressive disease for years 0-5 and 5-10 were evaluated by logistic regression analyses.Results: 82/168 (49%) patients had erosions at inclusion and almost all became erosive with time (90% after two years and 96% after 10 years). Radiographic progression was most rapid during the first two years and 75% of all damage occurred during the first five years. The median Larsen score increased from 6 at inclusion to 41 after five years and 54 after 10 years. Only 5.3% of all evaluated joints became maximally eroded, the second metacarpophalangeal joint being the most commonly affected. Mean ESR during the first three months and rheumatoid factor status were significant predictors for radiographic progressive disease, it was not possible to predict non-progressive disease.Conclusions: Joint damage in hands and feet developed early and progression was most rapid during the first years of disease. The different rates of progression at different stages should be considered in the design of trials of drugs aimed at retarding joint damage. Disease activity at study start influenced the degree of joint damage during the entire 10 years.