Repair of joint erosions in rheumatoid arthritis: prevalence and patient characteristics in a large inception cohort.
BACKGROUND
Joint destruction in rheumatoid arthritis (RA) was until recently seen as an irreversible state. Lately, it was found that repair of bone erosions occurs; however, little is known about its prevalence.


OBJECTIVE
To investigate the frequency of repair and patients' characteristics associated with repair in an inception cohort.


METHODS
250 patients with RA, included in the Leiden Early Arthritis Clinic between 1993 and 2000 and treated with conventional disease-modifying antirheumatic drugs, were studied (mean follow-up 10.1 years). Radiographs obtained annually were scored using the Sharp-van der Heijde method, initially aware of the chronology. Patients with a negative change in erosion scores on subsequent radiographs were selected and their series of radiographs were re-scored with concealed time sequence by three readers. Repair was defined as agreement between two readers of a negative change in erosion scores that persisted for at least 2 years.


RESULTS
Repair was identified in 32 joints in 18 patients (7.2%). Patients with repair had a greater prevalence of autoantibodies (rheumatoid arthritis, anti-citrullinated protein antibody) and a higher level of joint destruction. In the joints with repair, arthritis was absent in the 2 years preceding repair.


CONCLUSIONS
Repair occurred in 7.2% of the patients with RA, particularly in clinically inactive joints in patients with severe destructive disease.
van der Linden
Michael P M
MP
Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands. M.P.M.van_der_Linden@lumc.nl
Boja
Ramona
R
Klarenbeek
Naomi B
NB
Huizinga
Tom W J
TW
van der Heijde
Désirée M
DM
van der Helm-van Mil
Annette H M
AH
D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology*; D001323:Autoantibodies / Q000032:analysis; D001861:Bone Regeneration / Q000502:physiology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012074:Remission Induction; D012720:Severity of Illness Index
D018501:Antirheumatic Agents; D001323:Autoantibodies