title: The effect of treatment on radiological progression in rheumatoid arthritis: a systematic review of randomized placebo-controlled trials.
abstract: OBJECTIVE
  To undertake a systematic review of randomized placebo-controlled trials to assess and rank the efficacy of pharmacological interventions in preventing radiological progression of rheumatoid arthritis.
  
  
  METHODS
  The two outcome measures were the weighted standardized mean difference and the odds of progression of X-ray scores pooled as close to 12 months as possible to minimize heterogeneity.
  
  
  RESULTS
  A total of 38 trials were identified. Of these, 13 were excluded, leaving data on 3907 subjects. Infliximab, cyclosporin, sulphasalazine, leflunomide, methotrexate, parenteral gold, corticosteroids, auranofin and interleukin 1 receptor antagonist were statistically better than placebo in terms of change in erosion scores. All agents were equivalent statistically, with the exception of infliximab (which was superior to the last five agents). There were similar findings for the odds of progression, with the exception of auranofin (P=0.06) and the infliximab-methotrexate comparison (P=0.07). Other agents did not reach statistical significance in either outcome measure. With the exception of the antimalarials, the magnitude of the effect was consistent with the effect seen in short-term disease activity trials.
  
  
  CONCLUSIONS
  There is published evidence which supports the efficacy of nine agents in decreasing radiological progression in rheumatoid arthritis.
authors.affiliation: Menzies Centre for Population Health Research, GPO Box 252-23, Hobart, Tasmania 7000. g.jones@utas.edu.au
authors.forename: G
authors.initials: G
authors.lastname: Jones
authors.forename: J
authors.initials: J
authors.lastname: Halbert
authors.forename: M
authors.initials: M
authors.lastname: Crotty
authors.forename: E M
authors.initials: EM
authors.lastname: Shanahan
authors.forename: M
authors.initials: M
authors.lastname: Batterham
authors.forename: M
authors.initials: M
authors.lastname: Ahern
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D001175:Arthrography; D003625:Data Collection; D003627:Data Interpretation, Statistical; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D016032:Randomized Controlled Trials as Topic
chemical_list: D018501:Antirheumatic Agents