van der Heijde D M, van Leeuwen M A, van Riel P L, Koster A M, van 't Hof M A, van Rijswijk M H, van de Putte L B
Department of Rheumatology, University Hospital Nijmegen, The Netherlands.
Arthritis Rheum. 1992 Jan;35(1):26-34. doi: 10.1002/art.1780350105.
In a prospective followup study of 147 patients with rheumatoid arthritis of recent onset, we assessed the progression of radiographic evidence of joint damage on films of the patients' hands and feet obtained biannually. Patients were receiving first-line and second-line treatment. Ninety patients were followed up for 3 years, and 57 were followed up for only 2 years. Radiographic damage was determined by a modification of the method described by Sharp, and to ensure comparability of findings, we determined the percentage of damage per joint group (actual score divided by the maximum possible score). After 3 years, radiographic damage was present in 70% of the patients, all of whom could be identified after 1 year of study. Overall, 18-20% of the joints of the hands and feet were affected after 3 years, with relatively little abnormality per joint (approximately 8% of maximum possible score). During the entire followup, more foot joints than hand joints were affected. The rate of progression in the first year was significantly higher than in the second and third years of study, indicating a flattening of the curve of radiographic progression of joint damage.
在一项对147例近期发病的类风湿性关节炎患者的前瞻性随访研究中，我们评估了患者每年两次拍摄的手部和足部X线片上关节损伤的影像学证据进展情况。患者接受一线和二线治疗。90例患者随访3年，57例仅随访2年。影像学损伤采用对Sharp描述的方法进行修改后确定，为确保结果的可比性，我们确定了每个关节组的损伤百分比（实际得分除以最大可能得分）。3年后，70%的患者出现影像学损伤，所有这些患者在研究1年后即可识别。总体而言，3年后手部和足部关节的18% - 20%受到影响，每个关节的异常相对较少（约为最大可能得分的8%）。在整个随访期间，足部关节比手部关节受影响更多。第一年的进展速度明显高于研究的第二年和第三年，表明关节损伤影像学进展曲线趋于平缓。
