Clinical joint inactivity predicts structural stability in patients with established rheumatoid arthritis.
OBJECTIVE
Clinical joint activity is a strong predictor of joint damage in rheumatoid arthritis (RA), but progression of damage might increase despite clinical inactivity of the respective joint (silent progression). The aim of this study was to evaluate the prevalence of silent joint progression, but particularly on the patient level and to investigate the duration of clinical inactivity as a marker for non-progression on the joint level.


METHODS
279 patients with RA with any radiographic progression over an observational period of 3-5 years were included. We obtained radiographic and clinical data of 22 hand/finger joints over a period of at least 3 years. Prevalence of silent progression and associations of clinical joint activity and radiographic progression were evaluated.


RESULTS
120 (43.0%) of the patients showed radiographic progression in at least one of their joints without any signs of clinical activity in that respective joint. In only 7 (5.8%) patients, such silent joint progression would go undetected, as the remainder had other joints with clinical activity, either with (n=84; 70.0%) or without (n=29; 24.2%) accompanying radiographic progression. Also, the risk of silent progression decreases with duration of clinical activity.


CONCLUSIONS
Silent progression of a joint without accompanying apparent clinical activity in any other joint of a patient was very rare, and would therefore be most likely detected by the assessment of the patient. Thus, full clinical remission is an excellent marker of structural stability in patients with RA, and the maintenance of this state reduces the risk of progression even further.
Department of Rheumatology, Department of Medicine III , Medical University of Vienna , Vienna , Austria.
M
M
Gärtner
Department of Rheumatology, Department of Medicine III , Medical University of Vienna , Vienna , Austria.
I K
IK
Sigmund
Department of Rheumatology, Department of Medicine III , Medical University of Vienna , Vienna , Austria.
F
F
Alasti
Department of Rheumatology, Department of Medicine III , Medical University of Vienna , Vienna , Austria.
G
G
Supp
Department of Rheumatology, Department of Medicine III , Medical University of Vienna , Vienna , Austria.
H
H
Radner
Department of Rheumatology, Department of Medicine III , Medical University of Vienna , Vienna , Austria.
K
K
Machold
Department of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; 2nd Department of Medicine, Hietzing Hospital, Vienna, Austria.
J S
JS
Smolen
Department of Rheumatology, Department of Medicine III , Medical University of Vienna , Vienna , Austria.
D
D
Aletaha
Disease Activity; Outcomes research; Rheumatoid Arthritis