Radiologic assessment as an outcome measure in rheumatoid arthritis

Jt, Sharp

doi:10.1002/anr.1780320218

Cited by 105 publications

(47 citation statements)

References 49 publications

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“…In the ERA trial, each radiograph was read by 2 of 6 experts; inter-reader coefficients of correlation were 0.85 (21). These compare favorably with previously published interreader variabilities of Ն0.85 and intrareader correlation coefficients of 0.91-0.97 (35)(36)(37).…”

Section: Methodology For Demonstrating Retardation Of Radiographic Prsupporting

confidence: 90%

Radiographic data from recent randomized controlled trials in rheumatoid arthritis: What have we learned?

Strand¹,

Sharp²

2003

Arthritis & Rheumatism

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Section: Methodology For Demonstrating Retardation Of Radiographic Prsupporting

confidence: 90%

Radiographic data from recent randomized controlled trials in rheumatoid arthritis: What have we learned?

Strand¹,

Sharp²

2003

Arthritis & Rheumatism

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“…This trial highlights the need for standardization of imaging methods, scoring criteria, and evaluations and the subsequent analytic methods in trials of secondline therapies (28). If the rate of progression as assessed by imaging techniques is critical for classification of a drug as a disease-modifying agent, then a set of standardized imaging protocols or other imaging methods must be developed.…”

Section: Discussionmentioning

confidence: 99%

The effects of drug therapy on radiographic progression of rheumatoid arthritis. results of a 36‐week randomized trial comparing methotrexate and auranofin

Weinblatt

Polisson

Blotner

et al. 1993

Arthritis & Rheumatism

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Objective. To determine the effects of drug therapy (methotrexate [MTX] versus auranofin [AUR]) onradiographic progression in patients with active rheumatoid arthritis (RA).Methods. We conducted a 9-month randomized, multicenter, double-blind trial comparing MTX and AUR. Standardized radiographs of the hands and wrists were obtained at baseline and at completion of the study. Four experienced bone radiologists graded the radiographs for erosions, joint space narrowing, erosion healing, and reparative bone formation. Conclusion. The rate of radiographic progression in patients with RA, as measured by erosion score and joint space narrowing score, was demonstrated to be lower in those treated with MTX, as compared with AUR, over a 36-week period.The rate of radiographic progression is considered to be an important parameter of the efficacy of second-line therapy in rheumatoid arthritis (RA). Whether any second-line therapy in current use, including methotrexate (MTX), slows radiographic progression is uncertain (1,2). The clinical efficacy profile of MTX is, however, favorable, based on data from short-term randomized placebo-controlled trials (3-3, comparative studies with other second-line therapies ( 6 4 , and long-term prospective studies (9,lO). In a previously published report we described the clinical results of a 36-week multicenter study comparing MTX and auranofin (AUR) (11). The effect of treatment on radiographic activity has now been evaluated PATIENTS AND METHODSPatients. Two hundred eighty-one patients with active RA were enrolled in a multicenter double-blind trial comparing MTX and AUR (1 1). All patients had had inadequate disease response to at least 2 nonsteroidal antiinflammatory drugs (NSAIDs). Patients who had received prior treatment, of any duration, with gold salts, MTX, D-penicillamine, or cytotoxic agents were excluded from the study.Patients were randomized to receive either AUR (n = 143) or MTX (n = 138) for 9 months. (At 1 of the sites, only 1 patient was enrolled in the AUR group, and that patient was excluded from the efficacy analysis.) The initial dosage of AUR was 6 mg/day; this could be increased to 9 mg/day after 24 weeks of treatment, if there was a lack of a beneficial response with the lower dosage. The initial dosage of MTX was 7.5 mg/week, which could be increased to 15 mg/week between weeks 6 and 12 in patients who had not shown a clinical response. Patients were allowed to continue taking stable maintenance doses of background NSAIDs and/or prednisone (at a maximum dosage of 10 mg/day). Standard clinical assessments of arthritis activity were performed during the trial.Radiographic evaluation. Radiographs of the hands and wrists were obtained at baseline and at completion of the 9-month trial. A standardized protocol was used for obtaining these radiographs. All radiographs were taken on a single 30 X 35-cm cassette, with the patient in a posteroanterior position with the fingers slightly separated and the forearms flat. Each study center was provided with a Kodak (Ea...

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“…Indeed, it has been suggested that the pathophysiologic processes of joint inflammation and destruction may be partly independent, and erosions may continue despite effective suppression of inflammation and clinical improvement (12)(13)(14)(15). Radiographs of the hands and feet provide a semiquantitative measure of bone erosion and, indirectly, cartilage loss (16,17). This technique, however, has poor sensitivity, and when a radiologic diagnosis is established, there is often already significant joint damage.…”

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confidence: 99%

Association of baseline levels of markers of bone and cartilage degradation with long‐term progression of joint damage in patients with early rheumatoid arthritis

Garnero¹,

Landewé²,

Boers³

et al. 2002

Arthritis & Rheumatism

167

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Objective. The known risk factors for radiologic progression in rheumatoid arthritis (RA) are not optimally discriminative in patients with early disease who do not have evidence of radiologic damage. We sought to determine whether urinary C-terminal crosslinking telopeptide of type I (CTX-I) and type II (CTX-II) collagen (markers of bone and cartilage destruction, respectively) are associated with long-term radiologic progression in patients with early RA.Methods. This was a prospective study of 110 patients with early RA who were participating in the COBRA (Combinatietherapie Bij Reumatoïde Artritis) clinical trial and followup study, a randomized controlled trial comparing the efficacy of oral pulse prednisolone, methotrexate, plus sulfasalazine with sulfasalazine alone. We investigated the relationship between baseline levels of urinary CTX-I and CTX-II and the mean annual progression of joint destruction over a median of 4 years, as measured by changes in the modified Sharp score (average of 2 independent readers).Results. In multivariate logistic regression analysis, baseline urinary CTX-I and CTX-II levels in the highest tertile were the strongest predictors of radiologic progression (Sharp score increase >2 units/year; odds ratio 7.9 and 11.2, respectively), independently of treatment group, erythrocyte sedimentation rate (ESR), Disease Activity Score in 28 joints, rheumatoid factor (RF), and baseline joint damage (Sharp score). The likelihood ratios for a positive test were 3.8 and 8.0 for CTX-I and CTX-II, respectively, which compared favorably with the likelihood ratios for the ESR (3.0), baseline joint damage (1.6), and RF (1.8). When patients were grouped according to the presence (Sharp score >4, n ‫؍‬ 49) and absence (Sharp score <4, n ‫؍‬ 61) of joint damage at baseline, CTX-I and CTX-II levels were predictive only in those without baseline joint damage (odds ratio 14.9 and 25.7, respectively).Conclusion. High baseline levels of urinary CTX-I and CTX-II independently predict an increased risk of radiologic progression over 4 years in patients with early RA, especially those without radiologic joint damage. Urinary CTX-I and CTX-II may be useful for identifying individual RA patients at high risk of progression very early in the disease, before erosions can be detected radiographically. Such patients may be in special need of treatments that inhibit bone and cartilage degradation.

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Radiologic assessment as an outcome measure in rheumatoid arthritis

Cited by 105 publications

References 49 publications

Radiographic data from recent randomized controlled trials in rheumatoid arthritis: What have we learned?

Radiographic data from recent randomized controlled trials in rheumatoid arthritis: What have we learned?

The effects of drug therapy on radiographic progression of rheumatoid arthritis. results of a 36‐week randomized trial comparing methotrexate and auranofin

Association of baseline levels of markers of bone and cartilage degradation with long‐term progression of joint damage in patients with early rheumatoid arthritis

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