title: Radiographic progression of large joint damage in patients with rheumatoid arthritis treated with biological disease-modifying anti-rheumatic drugs.
abstract: OBJECTIVE
  Radiographic progression of damage to the small joints in patients with rheumatoid arthritis (RA) is well known; however, it has not been studied fully in the large joints. In this study, we looked at the prevalence of radiographic progression of large joint damage in patients with RA treated with biological disease-modifying anti-rheumatic drugs (bDMARDs).
  
  
  METHODS
  A total of 273 large joints in the upper and lower extremities of 67 patients with RA treated with bDMARDs were investigated. Radiographs for tender and/or swollen large joints were taken at least twice during the study period (mean 18.6 months), and the progression of damage was evaluated.
  
  
  RESULTS
  Progressive damage was found in 20.9% of patients and 6.2% of joints. A multivariate analysis revealed that the Larsen grade (LG) alone was a risk factor for progressive damage. The LG cutoff value was determined to be 2.5 (sensitivity: 0.529, specificity: 0.805).
  
  
  CONCLUSIONS
  The only factor to predict progressive damage was the LG of the joints with symptoms, and the damage must be stopped within LG II. Regular radiographic examinations for large joints should be performed in addition to routine examinations for small joints, such as the hand and foot.
authors.affiliation: a Department of Orthopedics and.|b Department of Rheumatology , Toho University Sakura Medical Center , Sakura-shi, Chiba , Japan .
authors.forename: Arata
authors.initials: A
authors.lastname: Nakajima
authors.affiliation: c Department of General Medical Sciences , Graduate School of Medicine, Chiba University , Chuo-ku, Chiba-shi, Chiba , Japan .|d Department of Orthopedic Surgery , Eastern Chiba Medical Center , Togane-shi, Chiba , Japan , and.
authors.forename: Yasuchika
authors.initials: Y
authors.lastname: Aoki
authors.affiliation: a Department of Orthopedics and.
authors.forename: Masato
authors.initials: M
authors.lastname: Sonobe
authors.affiliation: a Department of Orthopedics and.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: a Department of Orthopedics and.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Saito
authors.affiliation: e Department of Rehabilitation , Toho University Sakura Medical Center , Sakura-shi, Chiba , Japan.
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Terayama
authors.affiliation: a Department of Orthopedics and.
authors.forename: Koichi
authors.initials: K
authors.lastname: Nakagawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D001688:Biological Products / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products
keywords: Biological disease-modifying anti-rheumatic drugs; Large joints; Progression of damage; Rheumatoid arthritis