Hulsmans H M, Jacobs J W, van der Heijde D M, van Albada-Kuipers G A, Schenk Y, Bijlsma J W
Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, The Netherlands.
Arthritis Rheum. 2000 Sep;43(9):1927-40. doi: 10.1002/1529-0131(200009)43:9<1927::AID-ANR3>3.0.CO;2-B.
To describe the radiologic course in a large cohort of patients with early rheumatoid arthritis (RA) and to analyze individual components of damage.
Five hundred two patients with recent-onset RA (disease duration <1 year) underwent annual radiologic assessment for a maximum of 6 years in this longitudinal prospective study. The study was designed to investigate the efficacy of 3 different therapeutic strategies. For the assessment of radiologic damage, radiographs of the hands and feet were scored according to the modified Sharp/van der Heijde method (SHS; range 0-448). A mean of 2.9 (range 1-7) radiographs was read per patient.
Stable rates of progression of the SHS, erosion score, and narrowing score were found over the course of RA: the mean rates were 8.6, 5.4, and 3.2 modified Sharp units per year, respectively. The rate of progression of newly (not previously) damaged joints declined, and the rate of progression of already damaged joints (which became more damaged) increased during followup, leading to an equal contribution to progression of the SHS at 5 years. The joints of the feet, especially the fifth metatarsophalangeal joint, generally became eroded earlier and more of them became eroded compared with the joints of the hands.
Radiologic damage progresses at a constant rate. In advanced disease, monitoring the progression of previously existing damage is as important as assessing new abnormalities in previously undamaged joints. Radiographs of the feet should be included in assessments of radiologic damage that are used in clinical intervention trials and daily practice.
描述一大群早期类风湿关节炎（RA）患者的放射学病程，并分析损伤的各个组成部分。
在这项纵向前瞻性研究中，502例近期发病的RA患者（病程<1年）接受了为期6年的年度放射学评估。该研究旨在调查3种不同治疗策略的疗效。为评估放射学损伤，根据改良的Sharp/van der Heijde方法（SHS；范围0 - 448）对双手和双足的X线片进行评分。每位患者平均读取2.9张（范围1 - 7张）X线片。
在RA病程中发现SHS、侵蚀评分和狭窄评分的进展率稳定：平均进展率分别为每年8.6、5.4和3.2个改良Sharp单位。随访期间，新出现（之前未出现）损伤的关节进展率下降，而已损伤关节（损伤加重）的进展率增加，导致5年时对SHS进展的贡献相同。与手部关节相比，足部关节，尤其是第五跖趾关节，通常更早出现侵蚀，且侵蚀的关节更多。
放射学损伤以恒定速率进展。在疾病晚期，监测先前存在损伤的进展与评估先前未损伤关节的新异常同样重要。足部X线片应纳入临床干预试验和日常实践中使用的放射学损伤评估。
