Radiographic outcome of recent-onset rheumatoid arthritis: A 19-year study of radiographic progression

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Abstract
Objective To describe the longitudinal radiographic course of rheumatoid arthritis (RA), and to identify and quantitate predictors of radiographic progression. Methods This prospective, longitudinal study of radiographic progression and clinical predictors of RA involved 256 patients with RA who were seen within the first 2 years of disease (mean 0.77 years) and were followed up for up to 19 years. Participants underwent a total of 6,278 clinical assessments (mean 24.5) and 934 paired radiographs (mean 3.1, range 2‐6). Clinical assessments at every visit included determination of the erythrocyte sedimentation rate (ESR), grip strength, pain scores, tender joint counts, and anxiety and depression measurements. Regression analyses utilized time‐integrated predictors. Results Overall, radiographic progression rates, as measured by the summary Sharp scores, appeared constant over the course of RA. The strongest correlate of progression was the time‐integrated ESR (ρ = 0.53). This association grew stronger with time. At 0‐5 years, 5‐10 years, 10‐15 years, and 15‐20 years, correlations were 0.40, 0.50, 0.65, and 0.74, respectively, and for the period 10‐20 years, the correlation was 0.67. In multivariate models, the mean ESR, mean grip strength, rheumatoid factor positivity, and tender joint count were independent predictors of radiographic progression. Conclusion Radiographic damage occurs at a constant rate in RA, and is not greater early in RA or reduced later in the course of the illness. Acute‐phase reactants are, by far, the strongest determinants of progression.