Effects of Hydroxychloroquine and Sulphasalazine on Progression of Joint Damage in Rheumatoid Arthritis

Superior efficacy of combination therapy for rheumatoid arthritis: Fact or fiction?

“…The study by Trnavsky et al (22), which demonstrated the superiority of HCQ plus MTX over HCQ monotherapy, illustrates this point. The superiority of the DMARD combination over HCQ likely reflects the inclusion of MTX in the combination arm, a notion supported by the significant inferiority of HCQ, which was also seen in other studies (23). In contrast, the study by Ferraz et al (14), which demonstrated superiority of the combination of HCQ and MTX over MTX alone, is far more clinically relevant.…”

“…The study by Calguneri et al (20), for example, suggests radiographic benefit of combination triple therapy with MTX, HCQ, and SSZ or dual therapy with MTX plus HCQ or SSZ compared with monotherapy with MTX, HCQ, or SSZ; radiographs were evaluated by readers who were blinded to the clinical outcome. However, the monotherapy arm consisted of 3 different DMARDs, with only one-third of the patients receiving MTX but another one-third receiving HCQ, which does not have significant radiographic benefit (23). The study was therefore biased in favor of a DMARD combination consisting of more effective disease-modifying agents versus a monotherapy arm with little expected radiographic benefit.…”

Association of the –2849 interleukin‐10 promoter polymorphism with autoantibody production and joint destruction in rheumatoid arthritis

“…We next studied the relationship between IL-10 genotype and joint destruction. The mean rate of joint damage, as measured by the modified Sharp/Van der Heijde method using radiographs of the hands and feet (13), in the RA patients who were -2849 G carriers was compared with that in RA patients who were non-G carriers. At baseline, no difference in joint damage was observed between the G-carriers and non-G carriers (Figure 1).…”

“…These radiographs were scored in random order for the presence of erosions and joint space narrowing by an experienced rheumatologist who was blinded as to the patients' clinical data. The reported scores are the Sharp/Van der Heijde total damage scores (13). The intraclass correlation coefficient for the assessor's scoring was 0.95.…”

How to diagnose rheumatoid arthritis early: A prediction model for persistent (erosive) arthritis

“…The presence of HLA class II regions with RA predisposition, i.e., the shared epitope and DQ RA , were determined as described previously (14,15). The radiographs of the hands and feet were scored for the presence of erosions using the modified Sharp score (16,17) by an experienced rheumatologist who was blinded to the patient's other data.…”