title: Large-joint damage in patients with early rheumatoid arthritis and its association with treatment strategy and damage of the small joints.
abstract: OBJECTIVE
  To determine the prevalence of large-joint damage and the association with small-joint damage in patients with RA after 8 years of low DAS (≤2.4)-targeted treatment with different treatment strategies.
  
  
  METHODS
  Radiological data of 290 patients participating in the BeSt study, a randomized trial comparing initial monotherapy and initial combination therapy strategies, were used. Radiographs of large joints were scored using the Larsen score and of the small joints using the Sharp-van der Heijde score. With multivariate logistic regression analysis, an association between total damage of the small joints and of the large joints was investigated.
  
  
  RESULTS
  After 8 years of treatment, damage was observed in 12% of shoulders, 10% of elbows, 26% of wrists, 13% of hips, 18% of knees and 7% of the ankles. Damage in one or more large joints was found in 64% of patients, with a median score of 1. No difference was found between initial monotherapy or combination therapy strategies. There was a significant association between damage progression in small joints and damage to one or more large joints (OR 1.02; 95% CI 1.00-1.04).
  
  
  CONCLUSIONS
  After 8 years of DAS-targeted treatment in early RA patients, large-joint damage was found in 64% of patients and was associated with small-joint damage. Continued DAS-targeted treatment is probably more important in damage suppression than initial treatment strategy. Patients with more damage to hands and feet also have more damage to the large joints.
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. l.dirven@lumc.nl
authors.forename: Linda
authors.initials: L
authors.lastname: Dirven
authors.forename: Marianne
authors.initials: M
authors.lastname: van den Broek
authors.forename: Herman M
authors.initials: HM
authors.lastname: Kroon
authors.forename: Bernard A M
authors.initials: BA
authors.lastname: Grillet
authors.forename: K Huub
authors.initials: KH
authors.lastname: Han
authors.forename: Pit J S M
authors.initials: PJ
authors.lastname: Kerstens
authors.forename: Tom W J
authors.initials: TW
authors.lastname: Huizinga
authors.forename: Willem F
authors.initials: WF
authors.lastname: Lems
authors.forename: Cornelia F
authors.initials: CF
authors.lastname: Allaart
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D001175:Arthrography; D016000:Cluster Analysis; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D000069285:Infliximab; D007596:Joints / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000069285:Infliximab; D011241:Prednisone