title: Reductions in Radiographic Progression in Early Rheumatoid Arthritis Over Twenty-Five Years: Changing Contribution From Rheumatoid Factor in Two Multicenter UK Inception Cohorts.
abstract: To assess the 5-year progression of erosions and joint space narrowing (JSN) and their associations with rheumatoid factor (RF) status in 2 large, multicenter, early rheumatoid arthritis cohorts, spanning 25 years.
  
  
  
  Radiographic joint damage was recorded using the Sharp/van der Heijde (SHS) method in the Early Rheumatoid Arthritis Study (ERAS), 1986-2001, and the Early Rheumatoid Arthritis Network (ERAN), 2002-2013. Mixed-effects negative binomial regression estimated changes in radiographic damage over 5 years, including erosions and JSN, separately. RF, along with age, sex, and baseline markers of disease activity were controlled for.
  
  
  
  A total of 1,216 patients from ERAS and 446 from ERAN had radiographic data. Compared to ERAS, ERAN patients had a lower mean total SHS score at baseline (ERAN 6.2 versus ERAS 10.5; P < 0.001) and mean annual rate of change (ERAN 2.5 per year versus ERAS 6.9 per year; P < 0.001). Seventy-four percent of ERAS and 27% of ERAN patients progressed ≥5 units. Lower scores at baseline in ERAN were largely driven by reductions in JSN (ERAS 3.9 versus ERAN 1.2; P < 0.001), along with erosions (ERAS 1.9 versus ERAN 0.8; P < 0.001). RF was associated with greater progression in each cohort, but the absolute difference in mean annual rate of change for RF-positive patients was substantially higher for ERAS (RF positive 8.6 versus RF negative 5.1; P < 0.001), relative to ERAN (RF positive 2.0 versus RF negative 1.9; P = 0.855).
  
  
  
  Radiographic progression was shown to be significantly reduced between the 2 cohorts, and was associated with lower baseline damage and other factors, including changes in early disease-modifying antirheumatic drug use. The impact of RF status as a prognostic marker of clinically meaningful change in radiographic progression has markedly diminished in the context of more modern treatment.
authors.affiliation: Centre for Clinical and Health Service Research, University of Hertfordshire, Hatfield, UK.
authors.forename: Lewis
authors.initials: L
authors.lastname: Carpenter
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, University of Hertfordshire, Hatfield, UK.
authors.forename: Sam
authors.initials: S
authors.lastname: Norton
authors.affiliation: Whittington Hospital NHS Trust, London, UK.
authors.forename: Elena
authors.initials: E
authors.lastname: Nikiphorou
authors.affiliation: University of Hertfordshire, Hatfield, UK.
authors.forename: Keeranur
authors.initials: K
authors.lastname: Jayakumar
authors.affiliation: Arthritis UK Pain Centre, University of Nottingham, Nottingham, UK.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: McWilliams
authors.affiliation: Centre for Clinical and Health Service Research, University of Hertfordshire, Hatfield, UK.
authors.forename: Kirsten L
authors.initials: KL
authors.lastname: Rennie
authors.affiliation: New Cross Hospital, Wolverhampton, UK.
authors.forename: Josh
authors.initials: J
authors.lastname: Dixey
authors.affiliation: St Georges University Hospitals NHS Foundation Trust, London, UK.
authors.forename: Patrick
authors.initials: P
authors.lastname: Kiely
authors.affiliation: Arthritis UK Pain Centre, University of Nottingham, Nottingham, UK.
authors.forename: David Andrew
authors.initials: DA
authors.lastname: Walsh
authors.affiliation: University of Hertfordshire, Hatfield, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Young
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D005260:Female; D006801:Humans; D007596:Joints / Q000000981:diagnostic imaging*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012217:Rheumatoid Factor / Q000097:blood*; D012720:Severity of Illness Index; D013997:Time Factors; D006113:United Kingdom
chemical_list: D018501:Antirheumatic Agents; D015415:Biomarkers; D012217:Rheumatoid Factor