title: Have radiographic progression rates in early rheumatoid arthritis changed? A systematic review and meta-analysis of long-term cohorts.
abstract: To evaluate, firstly, all published data on baseline and annual progression rates of radiographic damage from all longitudinal observational cohorts, and secondly, the association of standard clinical and laboratory parameters with long-term radiographic joint damage.
  
  
  
  A comprehensive search of the literature from 1975 to 2014, using PubMed, SCOPUS and Cochrane databases, identified a total of 28 studies that investigated long-term radiographic progression, and 41 studies investigating predictors of long-term radiographic progression. This was submitted and approved by PROSPERO in February 2014 (Registration Number: CRD42014007589).
  
  
  
  Meta-analysis indicated an overall baseline rate of 2.02%, and a yearly increase of 1.08% of maximum damage. Stratified analysis found that baseline radiographic scores did not differ significantly between cohorts recruiting patients pre- and post-1990 (2.01% vs 2.03%; P > 0.01); however, the annual rate of progression was significantly reduced in the post-1990 cohorts (0.68% vs 1.50%; P < 0.05). High levels of acute phase markers, baseline radiographic damage, anti-CCP and RF positivity remain consistently predictive of long-term radiographic joint damage.
  
  
  
  Critical changes in treatment practices over the last three decades are likely to explain the reduction in the long-term progression of structural joint damage. Acute phase markers and presence of RF/anti-CCP are strongly associated with increased radiographic progression.
authors.affiliation: Centre for Lifespan and Chronic Illness Research.
authors.forename: Lewis
authors.initials: L
authors.lastname: Carpenter
authors.affiliation: Postgraduate Medicine, University of Hertfordshire, Hatfield.
authors.forename: Elena
authors.initials: E
authors.lastname: Nikiphorou
authors.affiliation: Centre for Lifespan and Chronic Illness Research.
authors.forename: Rachel
authors.initials: R
authors.lastname: Sharpe
authors.affiliation: Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London.
authors.forename: Sam
authors.initials: S
authors.lastname: Norton
authors.affiliation: Centre for Lifespan and Chronic Illness Research.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Rennie
authors.affiliation: Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield.
authors.forename: Frances
authors.initials: F
authors.lastname: Bunn
authors.affiliation: Department of Rheumatology, Kings College London, London.
authors.forename: David L
authors.initials: DL
authors.lastname: Scott
authors.affiliation: Department of Rheumatology, New Cross Hospital, Wolverhampton and.
authors.forename: Josh
authors.initials: J
authors.lastname: Dixey
authors.affiliation: Postgraduate Medicine, University of Hertfordshire, Hatfield, Rheumatology Department, St Albans City Hospital, St Albans, UK adam.young@nhs.net.
authors.forename: Adam
authors.initials: A
authors.lastname: Young
keywords: meta-analysis; predictive models; radiographic progression; rheumatoid arthritis; systematic review