Does second-line therapy affect the radiological progression of rheumatoid arthritis?

Use of the radiograph to measure the course of rheumatoid arthritis

“…However, all film readers find any one of the scoring methods used to evaluate the progression of RA to be tedious and time consuming. Pullar et a1 (7) have recently determined that in any meaningful assessment of trial drug therapy, one would need to evaluate 120 patients receiving placebo and 120 patients receiving the trial drug over a period of 2 years. In addition, appropriate radiographs would be required at study entry and after 1 year and 2 years.…”

Therapeutic progress I: Current treatment of rheumatoid arthritis

“…Methotrexate (MTX) tends to be used in relatively unresponsive RA. Between 30 and 70% of patients have significant clinical improvement while taking MTX (39) which becomes evident after 4-6 weeks of therapy.…”

“…The group of drugs known as disease modifying antirheumatic drugs (DMARDs), or 'second-line agents', have been shown to slow down or modify the progression of the rheumatoid disease process. They suppress synovitis and cause a parallel reduction in the acute phase response (APR) (29) and also tend to improve radiographic outcome (30).…”

Radiological evaluation of erosions: a quantitative method for assessing long‐term remittive therapy in rheumatoid arthritis.

“…Of 109 patients, 36% showed progression of subarticular erosion and 22% showed progression of joint erosion. Finally a recent report from Glasgow reported only a tendency for improvement on low doses of penicillamine (Pullar et al, 1984). On balance, it seems clear that penicillamine, if it is to be genuinely remission inducing, must be administered at very high dosage, with the attendant risk of serious side effects.…”

“…My own experience is that erosions progressed rapidly in 17 of 41 patients treated with levamisole over a 4 year period. Others have suggested that progression may occur (Pullar et al, 1984).…”