Jonathan scott coblyn brigham and womens3/16/2023 Radiographs of both hands were obtained at baseline and 2 years. Thus, rather than focusing on who will develop erosions or has stable erosions, we characterized patients who have not developed erosions nor did so during a 2-year follow-up and attempted to identify predictors. In addition, identifying this group and its clinical characteristics will facilitate genetic and biologic studies that can further elucidate the pathogenesis of RA and its subtypes. However, an improved understanding of Group 3 RA patients who remain erosion free, will inform practitioners regarding patients who would likely have minimal joint damage regardless of therapy. Most clinical studies and trials concentrate on Group 1 RA patients who have progressive erosive disease, because they stand to benefit the most from early aggressive treatment. A review of clinical trial data found that subjects with RA duration >1–2 years without bone erosions at baseline were unlikely to develop bone erosions during treatment. In one 10-year prospective cohort study, ∼17% of RA subjects remained erosion free. Few studies focus on the third group of RA patients who remain erosion free during follow-up. Therefore, understanding predictors for who will remain erosion free is not a simple converse of the predictors for progressors. In prospective cohort studies and clinical trials, RA subjects with progressive erosive disease (Group 1) are compared with those who do not progress, which includes those with erosions and do not progress (Group 2) and those who never develop erosions (Group 3). Three subgroups of RA patients can be delineated with respect to bone erosions: Group 1-patients who develop or have worsening bone erosions over time despite treatment Group 2-patients who present with erosions, but the erosions remain unchanged over time and Group 3-patients who present without erosions and remain erosion free. In some patients, the disease process ultimately destroys affected joints. RA is a chronic inflammatory joint disease that, if left untreated, leads to damage of articular cartilage and development of bone erosions. Few baseline clinical characteristics significantly predicted erosion-free status. In our cohort, 21% of subjects were erosion free at baseline and 2 years. In the multivariable-adjusted analysis, significant predictors of erosion-free status were younger age at onset and shorter RA duration.Ĭonclusion. Treatments for RA did not differ between the two groups. Mean RA duration for erosion-free subjects was 3.9 years compared with 4.6 years in erosive subjects. Forty-six per cent ( n = 26) of this group was anti-CCP positive compared with 56% ( n = 121) in subjects with erosions present. Of the 271 subjects included, 21% ( n = 56) were considered erosion free. Variables with P ≤ 0.25 in the univariate analyses were assessed using backward selection in multivariable logistic regression models. We assessed baseline values of the following as potential correlates: age at RA onset, gender, RA duration, BMI, 28-joint DAS (DAS-28), CRP, anti-CCP status, tender and swollen joint counts, functional status, tobacco use and RA treatments. The primary outcome was erosion-free status at baseline and 2-year follow-up. We studied patients with bilateral hand radiographs at cohort baseline and 2-year follow-up assessed with Sharp/van der Heijde scores (SHS). Our study was conducted within a prospective observational cohort of RA patients recruited from the outpatient practice of an academic medical centre. Our objective was to characterize the group of RA patients without erosions and identify its clinical predictors. Treatment algorithms in RA include factors associated with poor prognosis however, many patients remain erosion free despite years of disease.
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