Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.
J Rheumatol. 2011 Jan;38(1):44-52. doi: 10.3899/jrheum.100514. Epub 2010 Oct 15.
to describe the longterm clinical and radiological outcomes in rheumatoid arthritis (RA) in a cohort in northwestern Greece; and to investigate predictive factors of radiological damage at the 10-year followup in patients with RA.
we studied the disease course and outcome of 144 patients with RA and radiographs of the hands and wrists available at baseline and at 10 years. Baseline measurements and time-averaged measures of swollen joint count (SJC) and inflammatory markers [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)] were tested in univariate analysis, and then those presenting a statistically significant association with either Larsen score at 10 years or annual progression rate were included in 2 logistic regression models in order to determine relevant independent prognostic factors.
a significant clinical improvement was noted, associated with a decrease of inflammatory markers along the timepoints. Larsen score and the number of erosive joints were increased. In the univariate analysis, both final Larsen score at 10 years and accelerated annual radiological progression rate were significantly associated with baseline radiographic measurements (Larsen score and number of erosive joints), the presence of autoantibodies [anticyclic citrullinated peptide antibodies (anti-CCP) and rheumatoid factor of IgA and IgM isotype], disease duration, and time-averaged measures of ESR, CRP, and SJC. In the logistic regression analysis, the baseline Larsen score, anti-CCP antibodies, and time-averaged CRP presented significant and independent associations with Larsen score at 10 years. An accelerated annual radiological progression rate was also predicted by baseline Larsen score and time-averaged measures of SJC and CRP.
despite clinical improvement, the radiologic progression of RA continues over time, because of the underlying inflammatory process. Baseline radiographic damage, anti-CCP antibodies, and time-averaged CRP constitute the main predictive factors of poor radiologic outcome in the long term.
描述希腊西北部一组类风湿关节炎（RA）患者的长期临床和影像学结果；并探讨 RA 患者 10 年随访时影像学损害的预测因素。
我们研究了 144 例 RA 患者的疾病过程和结局，以及基线和 10 年时手部和腕部的 X 线片。在单变量分析中，检测基线测量值和时间平均的肿胀关节计数（SJC）和炎症标志物[红细胞沉降率（ESR）和 C 反应蛋白（CRP）]，然后将与 10 年时 Larsen 评分或年进展率有统计学显著关联的指标纳入 2 个逻辑回归模型，以确定相关的独立预后因素。
观察到明显的临床改善，与炎症标志物随时间的下降有关。Larsen 评分和侵蚀性关节数增加。在单变量分析中，最终 10 年时的 Larsen 评分和加速的年放射学进展率与基线放射学测量值（Larsen 评分和侵蚀性关节数）、自身抗体[环瓜氨酸肽抗体（抗-CCP）和 IgA 和 IgM 同种型类风湿因子]的存在、疾病持续时间以及 ESR、CRP 和 SJC 的时间平均测量值显著相关。在逻辑回归分析中，基线 Larsen 评分、抗-CCP 抗体和时间平均 CRP 与 10 年时的 Larsen 评分呈显著独立相关。加速的年放射学进展率也可由基线 Larsen 评分和时间平均 SJC 和 CRP 预测。
尽管临床改善，但由于潜在的炎症过程，RA 的放射学进展仍在持续。基线放射学损害、抗-CCP 抗体和时间平均 CRP 是长期不良放射学结局的主要预测因素。
