Despite advances in therapeutics, patients with rheumatoid arthritis continue to exhibit joint destruction
Dalal Alkhudair, Khizer Iqbal, Trevor Duffy, Carl Orr
Connolly Hospital, RCSI
Whether the presence of erosive disease on plain film radiography represents an important, measurable outcome in rheumatoid arthritis (RA) in the modern era of therapeutics, has become controversial. Many experience none or little joint damage appreciably by radiography, and fewer experience functional limitations as a result of these observations on radiographs. Nevertheless, several imaging modalities have been shown to accurately identify joint destruction.
How often, in the current era of therapeutics for RA, do patients go on to develop erosive disease, outside of clinical trials, is poorly reported. We sought to examine the prevalence of progression to erosive disease those diagnosed treated for RA in the current era have.
77 consecutive patients with RA were followed and index and follow up radiographs were examined for the presence or absence of erosions on plain film radiographs of hands and feet, at index and follow up.
34/77 (44.1%) had evidence of erosive disease at most recent follow up imaging. 8/34 (23.5%) of these patients had erosive disease on their index radiographs. 26/34 (76.5%) had evidence of the development of erosive disease, since their index radiographs.
Higher CRP’s were statistically significantly associated with the presence of erosions (p=0.03). All other comparators, including disease duration, DAS28-CRP or ESR, serology profile, or smoking status were not significant.
Patients with RA commonly continue to develop erosive disease, despite advances in therapeutics. More research is needed to determine the significance of the ongoing development of erosive disease, despite improved clinical outcomes.