Clinical joint inactivity predicts structural stability in patients with established rheumatoid arthritis

Abstract

ObjectivesClinical joint activity is a strong predictor of joint damage in rheumatoid arthritis (RA), but progression of damage might increase despite clinical inactivity of the respective joint (silent progression). The aim of this study was to evaluate the prevalence of silent joint progression, but particularly on the patient level and to investigate the duration of clinical inactivity as a marker for non-progression on the joint level.Methods279 patients with RA with any radiographic progression over an observational period of 3–5 years were included. We obtained radiographic and clinical data of 22 hand/finger joints over a period of at least 3 years. Prevalence of silent progression and associations of clinical joint activity and radiographic progression were evaluated.Results120 (43.0%) of the patients showed radiographic progression in at least one of their joints without any signs of clinical activity in that respective joint. In only 7 (5.8%) patients, such silent joint progression would go undetected, as the remainder had other joints with clinical activity, either with (n=84; 70.0%) or without (n=29; 24.2%) accompanying radiographic progression. Also, the risk of silent progression decreases with duration of clinical activity.ConclusionsSilent progression of a joint without accompanying apparent clinical activity in any other joint of a patient was very rare, and would therefore be most likely detected by the assessment of the patient. Thus, full clinical remission is an excellent marker of structural stability in patients with RA, and the maintenance of this state reduces the risk of progression even further.

2016 update of the EULAR recommendations for the management of early arthritis

“…Swollen joint count and progression of joint damage have been consistently found to be associated 68 69. In addition, many trials have supported the use of a tight control of disease activity assessed via composite measures that include joint count evaluation 11 16 67 70.…”

Tenderness and radiographic progression in rheumatoid arthritis and psoriatic arthritis

“…All patients were included in an observational database where standard variables including joint counts are routinely assessed every 3–6 months and prospectively documented. Details of the database have been published elsewhere 21 22. Therapy with conventional synthetic/biological/targeted synthetic disease-modifying anti-rheumatic drugs (cs/b/tsDMARDs) was assessed at baseline and for the time period until the follow-up X-ray.…”

Upcoming value of gene expression analysis in rheumatology

“…Кроме того, в отличие от острой фазы, хроническое воспаление часто связано с генерацией специфического иммунного ответа с одновременным повреждением ткани [53]. При этом, повреждение может прогрессировать, несмотря на отсутствие клинической активности (немое прогрессирование) [109] вследствие низкой чувствительности клинических методов оценки воспаления сустава, субклинического синовита или системных эффектов, вызванных активными процессами в других суставах [110]. С другой стороны, сохранение остаточного синовиального воспаления, несмотря на клиническую ремиссию, ограничивает возможность репарации костных эрозий при РА [111].…”