Rate of radiographic progression of rheumatoid arthritis. Results of long-term observation

Introduction. Radiographic progression (RP) of rheumatoid arthritis (RA) is one of the main signs of the disease and a key factor in assessing the effectiveness of therapy. RP is accompanied by an increase in the number of erosions, narrowed joint spaces, and radiographic stage (Rg stage).

The aim – to compare the characteristics of patients with rheumatoid arthritis with rapid and slow rates of radiographic progression during long-term follow-up.

Materials and methods. A prospective cohort study lasting 9.7±1.7 years included 151 women with RA aged 53.9±9.2 years. All patients underwent clinical, laboratory, and radiographic examinations. RP was analyzed taking into account changes in the Steinbrocker RA stage, the number of erosions, and the degree of joint space narrowing using the Sharp/van der Heijde (SVH) method.

Results. An increase in the erosion count according to SVH was detected in 66 (53%) patients, and narrowed clefts – in 81 (65%) patients. The number of patients with Rg1, Rg2, and Rg3 decreased; those with Rg4 increased from 29 (19%) to 54 (36%) people (p<0.05). Slow RP (Rg1–Rg2 in dynamics) was observed in 63 (42%) patients, and rapid RP (increase in Rg stage) – in 32 (21%) patients. In 56 (37%) patients, the Rg stage did not change.

Rapid RP is associated with a younger age at RA onset and inclusion in the study, with a longer duration of RA, with a higher matrix metallopeptidase 3 index and interleukin 6 level above normal in dynamics, with a lower dose of methotrexate both in monotherapy and in combination with other agents; with a higher average daily and cumulative dose of glucocorticoids.

Conclusions. A long-term prospective study demonstrated RP despite achieving remission and decreasing activity in the majority of RA patients. The rate of RP depends on many factors, both RA-related and non-RA-related. Distinguishing phenotypes of RA patients with rapid and slow RP will enable a personalized approach to patient management.

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