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Early X-rays Predict Rheumatoid Arthritis Severity

May 8, 2014
Written by: , Filed in: Diagnostic Imaging, Musculoskeletal Radiology
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Rapid disease progression during the first year after diagnosis of rheumatoid arthritis, as measured by X-rays, strongly predicts a need for orthopedic surgery later, according to a presentation at last week’s Rheumatology 2014 annual meeting of the British Society for Rheumatology.

The findings would seem to support close X-ray monitoring of the disease after diagnosis. Lewis Carpenter, a PhD candidate in epidemiology at the University of Hertfordshire in Hatfield, United Kingdom, highlighted the importance of staying on top of the progression:

This helps build the case for early treatment in rheumatoid arthritis and adds to the argument for a therapeutic window of opportunity.

Carpenter was quoted in a MedPage Today article. Controlling the disease early, he said, can head off the need for surgery later.

Carpenter analyzed data from the Early Rheumatoid Arthritis Study in the UK. The study, which began in 1986, has 1,465 subjects. X-rays monitor erosions and severity of joint space narrowing. The radiographs are scored by either the Larsen or the newer Sharp/van der Heijde method. Carpenter determined that 4 units on the Larsen scale and 5 units on the Sharp/van der Heijde scale represented the minimum difference in progression that was clinically important.

He found that a change in Larsen score of 4 units during the first 12 months was associated with an 80 percent increased risk of subsequent surgery on the small joints of the hands and feet and a 50 percent increased risk of major surgery on the knee or hip. Using Sharp/van der Heijde scoring yielded similar results.

“It’s important to note that the Larsen and Sharp/van der Heijde scores only measure changes in the small joints of the hands and feet, not the large joints,” Carpenter said. “What is interesting was that the effect seen for the large joints was even stronger than for the small joints, suggesting a correlation between small joint radiographic progression and later large joint destruction.”

Related CME seminar (up to 13.5 AMA PRA Category 1 credits™): New Horizons in Musculoskeletal MRI


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