A combination of biochemical markers of cartilage and bone turnover, radiographic damage and body mass index to predict the progression of joint destruction in patients with rheumatoid arthritis treated with disease-modifying anti-rheumatic drugs A prediction rule for disease outcome in patients with undifferentiated arthritis using magnetic resonance imaging of the wrists and finger joints and serologic autoantibodies. Prediction of progression of radiologic damage in newly diagnosed rheumatoid arthritis. No overall progression and occasional repair of erosions despite persistent inflammation in adalimumab-treated rheumatoid arthritis patients: results from a longitudinal comparative MRI, ultrasonography, CT and radiography study Comparison of extracapsular changes by magnetic resonance imaging in patients with rheumatoid arthritis and polymyalgia rheumatica. Development of radiographic damage during the first 5-6 yr of rheumatoid arthritis. A prospective follow-up study of a Swedish cohort. Usefulness of magnetic resonance imaging of the hand versus anticyclic citrullinated peptide antibody testing to confirm the diagnosis of clinically suspected early rheumatoid arthritis in the absence of rheumatoid factor and radiographic erosions. Bone Marrow Edema Is the Most Specific Finding for Rheumatoid Arthritis (RA) on Noncontrast Magnetic Resonance Imaging of the Hands and Wrists: A Comparison of Patients with RA and Healthy Controls Rheumatoid arthritis of the shoulder joint: comparison of conventional radiography, ultrasound, and dynamic contrast-enhanced magnetic resonance imaging. Progression of radiographic joint damage in different eras: trends towards milder disease in rheumatoid arthritis are attributable to improved treatment. The progression of erosion and joint space narrowing scores in rheumatoid arthritis during the first twenty-five years of disease. Ultrasonographic predictors for the development of joint damage in rheumatoid arthritis patients: a single joint prospective study. Ultrasonography of the glenohumeral joints – a helpful instrument in differentiation in elderly onset rheumatoid arthritis and polymyalgia rheumatica MRI assessment of suppression of structural damage in patients with rheumatoid arthritis receiving rituximab: results from the randomised, placebo-controlled, double-blind RA-SCORE study Impact of a magnetic resonance imaging-guided treat-to-target strategy on disease activity and progression in patients with rheumatoid arthritis (the IMAGINE-RA trial): study protocol for a randomized controlled trial The ratio of circulating osteoprotegerin to RANKL in early rheumatoid arthritis predicts later joint destruction. Radiographic outcome of recent-onset rheumatoid arthritis: a 19-year study of radiographic progression.
The aim of this study was to evaluate the predictive value of biological , radiological and clinical parameters for the progression of radiographic joint damage in rheumatoid arthritis ( RA ) patients treated with conventional disease-modifying anti-rheumatic drugs ( DMARDs ) .  We analyzed the 145 patients with active RA for less than 5 years who were participating in the prospect i ve 1-year r and omized controlled trial of tocilizumab ( SAMURAI trial ) as a control arm treated with conventional DMARDs .  Progression of joint damage was assessed by sequential radiographs read by two independent blinded X-ray readers and scored for bone erosion and joint space narrowing ( JSN ) using the van der Heijde-modified Sharp method . Multivariate analysis revealed that increased urinary levels of C-terminal crosslinked telopeptide of type II collagen ( U-CTX-II ) , an increased urinary total pyridinoline/total deoxypyridinoline ( U-PYD/DPD ) ratio and low body mass index ( BMI ) at baseline were independently associated with a higher risk for progression of bone erosion . In addition to these three variables , the JSN score at baseline was also significantly associated with an increased risk of progression of the JSN score and total Sharp score . High baseline U-CTX-II levels , U-PYD/DPD ratio and JSN score and a low BMI are independent predictive markers for the radiographically evident joint damage in patients with RA treated with conventional DMARDs OBJECTIVE To evaluate whether magnetic resonance imaging ( MRI ) of the wrists and finger joints and an analysis of serologic autoantibodies are clinical ly meaningful for the subsequent development of rheumatoid arthritis ( RA ) in patients with undifferentiated arthritis ( UA ) . METHODS A total of 129 patients with UA , a disease status formally confirmed by a rheumatologist over a period of at least 1 year , were included .  Gadolinium-diethylenetriamine-enhanced MRI of both wrists and finger joints and serologic variables were examined upon admission to our Early Arthritis Clinic at Nagasaki University . After a prospect i ve followup of 1 year , a predictive value for the development of RA was determined for each patient . RESULTS The subjects were evaluated for their positive or negative status with respect to 3 objective measures at study entry : anti-cyclic citrullinated peptide ( anti-CCP ) antibodies and /or IgM-rheumatoid factor , MRI-proven symmetric synovitis , and MRI-proven bone edema and /or bone erosion . The patients who were positive for at least 2 of these measures progressed to RA at 1 year with a 79.7 % positive predictive value ( PPV ) , 63.0 % negative predictive value , 75.9 % specificity , 68.0 % sensitivity , and 71.3 % accuracy . Furthermore , in 22 UA patients positive for both anti-CCP antibodies and MRI-proven bone edema who were considered to have progressed to RA at 1 year , the PPV was increased to 100 % . A close correlation was found between the present rule and that established in the Leiden Early Arthritis Cohort . CONCLUSION MRI-proven early joint damage in conjunction with serologic autoantibodies is efficient in predicting progression from UA to RA . This method can be used to identify patients who would benefit from early treatment with disease-modifying antirheumatic drugs OBJECTIVE To investigate the extent to which early radiologic damage is predicted by joint inflammation in patients with newly diagnosed rheumatoid arthritis ( RA ) . METHODS Regression analysis was performed on 1-year progression of total radiologic damage for baseline characteristics and cumulative disease activity measures , and the effects of continued joint inflammation on the progression of damage in separate joint groups were investigated . RESULTS Odds ratios for progression of total damage were 12 for the presence of rheumatoid factor , 5 for the presence of damage at baseline , and 2 for cumulative joint inflammation . A positive association between continued joint inflammation and progression of damage was found to be statistically significant for most joint groups . CONCLUSION Progression of radiologic damage in patients with newly diagnosed RA is independently associated with the presence of rheumatoid factor and damage at baseline and with cumulative joint inflammation Aim To monitor joint inflammation and destruction in rheumatoid arthritis ( RA ) patients receiving adalimumab/methotrexate combination therapy using MRI and ultrasonography . To assess the predictive value of MRI and ultrasonography for erosive progression on CT and compare MRI/ultrasonography/radiography for erosion detection/monitoring . Methods Fifty-two erosive biological-naive RA patients were followed with repeated MRI/ultrasonography/radiography ( 0/6/12 months ) and clinical /biochemical assessment s during adalimumab/methotrexate combination therapy . Results No overall erosion progression or repair was observed at 6 or 12 months ( Wilcoxon ; p>0.05 ) , but erosion progressors and regressors were observed using the smallest detectable change cut-off . Scores of MRI synovitis , grey-scale synovitis ( GSS ) and power Doppler ultrasonography decreased after 6 and 12 months ( p<0.05 ) , as did DAS28 , HAQ and tender and swollen joint counts ( p<0.001 ) . Patients with progression on CT had higher baseline MRI bone oedema scores . The RR for CT progression in bones with versus without baseline MRI bone oedema was 3.8 ( 95 % CI 1.5 to 9.3 ) and time-integrated MRI bone oedema , power Doppler and GSS scores were higher in bones/joints with CT progression ( Mann – Whitney ; p<0.05 ) . With CT as the reference method , sensitivities/specificities for erosion in metacarpophalangeal joints were 68%/92 % , 44%/95 % and 26%/98 % for MRI , ultrasonography and radiography , respectively . Median intraobserver correlation coefficient was 0.95 ( range 0.44–0.99 ) . Conclusion During adalimumab/methotrexate combination therapy , no overall erosive progression or repair occurred , whereas repair of individual erosions was documented on MRI , and MRI and ultrasonography synovitis decreased . Inflammation on MRI and ultrasonography , especially MRI bone oedema , was predictive for erosive progression on CT , at bone/joint level and MRI bone oedema also at patient level OBJECTIVE Joint inflammation in polymyalgia rheumatica is regarded primarily as a disease of the synovial cavities and bursae , but the adjacent capsules and soft tissues have not been evaluated using sensitive imaging methods . We used fat suppression magnetic resonance imaging ( MRI ) to determine anatomical sites of inflammatory change in the shoulders of patients with early polymyalgia rheumatica ( PMR ) and a control group of patients with rheumatoid arthritis ( RA ) . METHODS Fourteen patients with PMR and 14 with RA ( a total of 20 shoulders in each group ) were evaluated .  T2 SPIR ( fat suppressed ) coronal oblique MRI sequences of the shoulders were performed . Scans were assessed for sites of joint effusion , bursitis , tenosynovitis , bone edema , and extracapsular soft tissue edema . Statistical analysis was performed using Fisher 's test . RESULTS Nine of 14 patients ( 10/20 joints ) with PMR but only 2/14 ( 2/20 joints ) with RA had prominent edema at extracapsular sites adjacent to the joint capsule or in the soft tissues ( p = 0.02 ) . Both groups had a comparable degree of joint effusion ( 18 PMR , 17 RA ) , bursitis ( 18 PMR , 16 RA ) , and tenosynovitis ( 3 PMR , 2 RA ) . CONCLUSION The only significant difference between the 2 groups was the presence of inflammatory change outside the joint cavity in patients with PMR . This may contribute to the diffuse nature of symptoms in PMR and have implication s for its pathogenesis The objective of this study was to describe the development of radiographic damage in patients with RA and to search for predictors of radiographic progression over 5 yr . One hundred and thirteen patients , 75 female and 38 male , mean age 53 yr , with definite RA and mean disease duration of 11.4 months , were followed prospect ively for 5 yr at an out-patient clinic .  Radiographs of the h and s and feet were performed annually , and evaluated according to Larsen . The predictive value of demographic , clinical and laboratory variables at study start was evaluated . A stepwise logistic regression model was applied . We found that radiological joint damage occurred early and was significantly progressive during the 5 study years . The rate of progression was most prominent during the first 2 yr . At study start , 53 % of the patients had no detectable erosions , but only 11 % remained non-erosive . Twenty-six per cent of the patients with the initial presence of erosions did not progress substantially and needed no aggressive therapy . High joint damage progression during the first year , female gender and high baseline ESR could predict 57 % of the patients with high total radiographic progression . Age , disease duration , rheumatoid factor , genetic factors , active joint count and the presence of erosions at study start had no predictive value OBJECTIVE The diagnosis of rheumatoid arthritis ( RA ) is sometimes difficult to establish early in the disease process , particularly in the absence of its classic hallmarks . Our aim was to compare the practical usefulness of magnetic resonance imaging ( MRI ) of the h and versus anticyclic citrullinated peptide ( anti-CCP ) antibody testing to confirm the diagnosis of clinical ly suspected RA in the absence of rheumatoid factor ( RF ) and radiographic erosions . METHODS We prospect ively included patients with early inflammatory arthritis and strong clinical suspicion of RA , in whom initial complementary tests ( RF and radiographs of h and s , wrists , and feet ) did not provide unequivocal confirmation of the diagnosis . In all patients , anti-CCP antibodies were assessed and contrast-enhanced MRI of the most affected h and was performed according to a specifically design ed protocol . The MRI criterion for the diagnosis of RA was either the presence of synovitis with bone erosions or bone marrow edema , which is currently considered to be a forerunner of erosions . RESULTS In the 40 patients ( 28 women ) , the mean age at diagnosis was 54 + /- 6 years and the median duration of symptoms was 4 + /- 2.6 months ( range 1.5 to 12 ) . Final diagnoses at 1-year follow-up were RA in 31 patients , undifferentiated arthritis in 7 ( 5 self-limiting ) , and psoriatic arthropathy ( PsA ) and antisynthetase syndrome in 1 patient each . Anti-CCP antibodies were positive only in 7 patients , all of whom were finally diagnosed with RA . The prevalence of anti-CCP positivity in our series of seronegative RA patients was thus 23 % ( 7/31 ) ; in these patients the anti-CCP antibodies had a specificity of 100 % ( 95 % CI : 71.7 to 100 ) and sensitivity of 23 % ( 95 % CI : 9.6 to 41.1 ) . Use of the MRI criterion led to the correct diagnosis in 100 % of patients with RA and to false-positive results ( 1 with PsA and 1 with antisynthetase syndrome ) . The MRI criterion had a specificity of 78 % ( 95 % CI : 40.0 to 97.2 ) and sensitivity of 100 % ( 95 % CI : 90.8 to 100 ) for identification of seronegative RA . CONCLUSION Although the tests are not mutually exclusive , in our experience MRI is more helpful than anti-CCP antibody determination in confirming the diagnosis of clinical ly suspected early RA in patients in whom the diagnosis can not be confirmed using conventional methods Objective . To evaluate the sensitivity and specificity of magnetic resonance imaging ( MRI ) in detecting erosions , bone edema , and synovitis in the metacarpophalangeal and wrist joints for rheumatoid arthritis ( RA ) . Methods . MRI scans of bilateral h and s and wrists of 40 healthy subjects and 40 RA patients were performed using 0.2 T extremity-MRI and read blindly using a modified RA MRI ( RAMRIS ) system ( no contrast injection , imaging in 1 plane only ) . To determine interreader reliability , images of 10 r and omly selected subjects were read independently by a musculoskeletal radiologist . Results . A total of 3360 bones were evaluated . Patients with RA had significantly more erosions as well as higher scores for bone edema and synovitis than healthy subjects . Age had a significant effect on the number of erosions in both groups . However , when disease duration was factored in , age became insignificant in RA patients . Erosion number correlated with positive rheumatoid factor and higher C-reactive protein values . The intraclass correlation coefficient between the 2 readers was 0.76 for individual joints and 0.88 for total scores . When having a single erosion was used as a positive test for RA , the sensitivity of this test was 90 % , but the specificity was only 35 % . Presence of bone edema provided 65 % sensitivity and 82.5 % specificity . Eliminating the lunate from scoring for bone edema increased the specificity to 87.5 % while decreasing the sensitivity to 62.5 % . Conclusion . While MRI is a highly sensitive tool for identifying and tracking the progression of erosions , erosions detected by MRI with measures commonly used in a rheumatologist ’s office ( no contrast , imaging in 1 plane ) provide low specificity for RA . Bone marrow edema is the most specific MRI lesion for RA in this setting OBJECTIVE To determine the role of ultrasound and magnetic resonance imaging ( MRI ) compared with conventional radiography in the detection of chronic and acute inflammatory manifestations of rheumatoid arthritis ( RA ) of the shoulder joint . METHODS Forty-three consecutive patients with known RA prospect ively underwent clinical examination , radiography , ultrasound , and MRI of the shoulder joints . Each patient was assigned a clinical /laboratory score consisting of 7 parameters , including measurements of shoulder mobility , the erythrocyte sedimentation rate , and C-reactive protein level .  Conventional radiography was st and ardized and performed in 2 planes . Ultrasound was performed in 10 predefined planes using a 7.5-MHz linear transducer . MRI at 1.5 T comprised transverse and oblique coronal T1- and T2 * -weighted fast spin-echo , gradient-echo ( GRE ) , and inversion-recovery sequences with a matrix size of up to 512 pixels . A dynamic T1-weighted GRE sequence was acquired with intravenous administration of contrast medium . Erosions were assessed using all 3 imaging techniques on a 4-point scale . Soft-tissue involvement was evaluated according to the presence of synovitis , tenosynovitis , and bursitis on ultrasound and MRI . The results in the study group were compared with those obtained in a control group of 10 patients with shoulder pain . RESULTS In the study group , erosions of the humeroscapular joint were detected by conventional radiography in 26 patients , by ultrasound in 30 patients , and by MRI in 39 patients ; the differences were statistically significant for the comparisons of conventional radiography with MRI and for ultrasound versus MRI ( P < 0.0001 ) . Conventional radiography detected 12 erosions of the scapula and MRI detected 15 . Synovitis was demonstrated in 12 patients by ultrasound and in 27 patients by MRI ( P = 0.0003 ) . Tenosynovitis was observed in 15 patients by ultrasound and in 28 patients by MRI ( P = 0.0064 ) . Bursitis was detected in 13 patients by ultrasound and in 18 patients by MRI . The findings on dynamic contrast-enhanced MRI correlated significantly with the detection of synovitis by ultrasound and erosions by static MRI ( P < 0.05 ) . CONCLUSION Ultrasound and MRI supplement conventional radiography in assessing the shoulder joint . Although conventional radiography can be used as the sole method of following up known joint destruction in RA , ultrasound and , preferably , MRI are recommended as additional techniques in the initial diagnostic evaluation when radiography yields negative results BACKGROUND Severity of rheumatoid arthritis and progression of radiographic joint damage have decreased over the last decades . AIM To examine whether this trend is attributable to an underlying trend towards milder disease or to improved treatment . METHODS The study used an inception cohort of patients with early rheumatoid arthritis seen at the Wichita Arthritis Center , Wichita , Kansas , USA , since 1973 and monitored prospect ively since their first clinic visit through clinical , radiographic , laboratory , demographic and self-reported data . The radiographic disease progression in patients with disease onset in the 1970s , 1980s and 1990s was compared using a multivariate regression model for longitudinal data . The analysis was adjusted for differences in baseline predictors , type of disease-modifying antirheumatic drugs ( DMARDs ) and steroid use . RESULTS 418 patients with rheumatoid arthritis with radiographic follow-up were included . Patients in earlier decades used fewer DMARDs , had longer disease duration s and higher tender joint counts at their first visit . Other important predictors of disease progression did not differ significantly between decades of disease onset . The unadjusted rates of radiographic progression differed between decades ( analysis of variance , p = 0.01 ) , with a significant trend towards less radiographic progression in more recent times ( trend , p<0.001 ) . However , after adjusting for DMARD use , steroid use and baseline predictors , differences between decades vanished ( analysis of variance , p = 0.40 ) and the trend towards less radiographic progression disappeared ( trend , p = 0.45 ) . CONCLUSION These results suggest that the observed trend towards milder disease in rheumatoid arthritis is attributable to more effective antirheumatic treatment and not to a secular trend Erosions and cartilage destruction are nearly universal features in peripheral joints that have been chronically affected by rheumatoid arthritis .  Scoring methods to measure the extent of these abnormalities in h and s and wrists have been developed and have been thoroughly tested in several studies to establish their reproducibility . In this study , we utilized one of these scoring methods to examine the progression of radiologic damage as related to duration of disease . Two hundred ninety-two patients from 3 different participating centers in the Arthritis , Rheumatism , and Aging Medical Information System were included . Six hundred fifty films of the h and s and wrists , obtained from 210 patients , were scored for  erosions and joint space narrowing . The average annual rate of progression of the total radiologic score , which sums erosion and joint space abnormalities and has a maximum possible score of 314 , was approximately 4 units per year over the first 25 years after onset ; this progression was more rapid in the earlier years of disease and slightly slower in the later years . Data were insufficient to accurately determine the progression rate in disease of more than 25 years duration OBJECTIVES This paper aims to evaluate if any ultrasonographic aspect of metacarpo-phalangeal ( MCP ) joint can be predictors for the development of new joint damage , at single joint level , in rheumatoid arthritis ( RA ) patients . METHODS Two hundred and forty MCP joints of 24 patients with RA were prospect ively evaluated both clinical ly and by ultrasound ( US ) at time 0 , at six months and 12 months , in order to collect the following variables : presence of synovial hypertrophy and power-Doppler ( PD ) vascularisation both grade d on a semiquantitative ( 0 - 3 ) scale , and the number and dimension of bone erosions . X-ray examinations were carried out at time 0 and at 12 months and lesions were grade d using the Sharp/van der Heijde ( S/vdH ) method at single joint level . Potential prognostic determinants for joint damage obtained at the first examination and during follow-up were entered in a conditional logistic regression analysis . RESULTS Fifteen out of seventeen ( 88 % ) of the new eroded joints on x-rays examination had persistent PD vascularity and 14/17 ( 82 % ) had persistent synovial thickening ( p=0.001 and p=0.02 , vs. non-eroded joints , respectively ) . In multiple conditional logistic regression analysis , the most important factor associated with the development of radiological joint damage was the presence of a synovial PD score ≥2 on two or more US evaluations ( OR 8.51 [ 95%CI 1.84 - 39.48 ] for Rx new erosions and OR 8.30 [ 95%CI 1.97 - 38.9 ] for increased S/vdH local joint score ) . Both baseline synovial score ≥2 and presence of Rx erosions were also significantly associated with the development of radiological joint damage . Two predictive models for x-ray erosions and total single joint level S/vdH damage score were constructed consisting of 2 baseline plus one longitudinal variable with a ROC AUC of 0.916 ( 95%CI 0.867 - 0.965 ) and 0.886 ( 95%CI 0.814 - 0.957 ) . CONCLUSIONS At the single joint level , the presence of US determined synovial thickness and PD signal at baseline and the persistent PD signal over time have relevant prognostic value for the development of articular damage in the same MCP joints of RA patients Abstract In a prospect i ve study , the glenohumeral joints of 51 patients ( aged 60 or above ) were examined , using ultrasonography .  Twenty-two patients were suffering from characteristic polymyalgia rheumatica ( PMR ) symptoms . In contrast , 29 other patients initially had similar complaints , but were diagnosed as having elderly onset rheumatoid arthritis ( EORA , rheumatoid factor negative ) upon development of typical symptoms . Ultrasound examination revealed glenohumeral joint inflammation in 40.9 % ( 9/22 ) of the patients with PMR and 65.5 % ( 19/29 ) of the patients with EORA . A discrete symmetrical biceps tendon sheath effusion was found in only three patients and unilateral in six patients with PMR . In contrast , 12 patients with EORA presented a massive effusion of the biceps tendon sheath , in some cases combined with a bilateral subdeltoid bursitis , and an intraarticular ( i.a . ) effusion/synovitis . To summarize our results : an i.a . effusion/synovitis , subdeltoid bursitis and biceps tendon sheath effusion were more frequent in patients with EORA , with a predominate symmetry and signs for massive inflammation . The typical ultrasonographic result in patients with PMR was a unilateral inflammation of the glenohumeral joint with predominate discrete biceps tendon sheath effusion and , in comparison with the EORA group , with signs of a low grade inflammation . We conclude that the results of our prospect i ve study might be helpful in the differentiation of PMR and a rheumatoid factor negative subgroup of EORA at the first time of manifestation where clinical overlaps can be observed . However , ultrasonography of the glenohumeral joints might be a good and helpful instrument of differentiation in both diseases Objective To evaluate changes in structural damage and joint inflammation assessed by MRI following rituximab treatment in a Phase 3 study of patients with active rheumatoid arthritis ( RA ) despite methotrexate ( MTX ) who were naive to biological therapy . Methods Patients were r and omised to receive two infusions of placebo ( n=63 ) , rituximab 500 mg ( n=62 ) , or rituximab 1000 mg ( n=60 ) intravenously on days 1 and 15 . MRI  scans and radiographs of the most inflamed h and and wrist were acquired at baseline , weeks 12 ( MRI only ) , 24 and 52 . The primary end point was the change in MRI erosion score from baseline at week 24 . Results Patients treated with rituximab  demonstrated significantly less progression in the mean MRI erosion score compared with those treated with placebo at weeks 24 ( 0.47 , 0.18 and 1.60 , respectively , p=0.003 and p=0.001 for the two rituximab doses vs placebo ) and 52 ( −0.30 , 0.11 and 3.02 , respectively ; p<0.001 and p<0.001 ) . Cartilage loss at 52 weeks was significantly reduced in the rituximab group compared with the placebo group . Other secondary end points of synovitis and osteitis improved significantly with rituximab compared with placebo as early as 12 weeks and improved further at weeks 24 and 52 . Conclusions This study demonstrated that rituximab significantly reduced erosion and cartilage loss at week 24 and week 52 in MTX-inadequate responder patients with active RA , suggesting that MRI is a valuable tool for assessing inflammatory and structural damage in patients with established RA receiving rituximab . Trial registration number Background Rheumatoid arthritis ( RA ) is a chronic , progressive joint disease , which frequently leads to irreversible joint deformity and severe functional impairment . Although patients are treated according to existing guidelines and reach clinical remission , erosive progression still occurs . This demonstrates that additional methods for prognostication and monitoring of the disease activity are needed . Bone marrow edema ( BME ) detected by magnetic resonance imaging ( MRI ) has proved to be an independent predictor of subsequent radiographic progression . Guiding the treatment based on the presence/absence of BME may therefore be clinical ly beneficial . We present the design of a r and omized controlled trial ( RCT ) aim ing to evaluate whether an MRI-guided treatment strategy compared to a conventional treatment strategy in anti-CCP-positive erosive RA is better to prevent progression of erosive joint damage and increase the remission rate in patients with low disease activity or clinical remission . Methods / design The study is a non-blinded , multicenter , 2-year RCT with a parallel group design . Two hundred anti-CCP-positive , erosive RA patients characterized by low disease activity or remission , no clinical ly swollen joints and treatment with synthetic disease-modifying antirheumatic drugs ( DMARDs ) will be included . Patients will be r and omized to either a treatment strategy based on conventional laboratory and clinical examinations ( control group ) or a treatment strategy based on conventional laboratory and clinical examinations as well as MRI ( intervention group ) . Treatment is intensified according to a predefined treatment algorithm in case of inflammation defined as a disease activity score ( DAS28 ) > 3.2 and at least one clinical ly swollen joint ( control and intervention groups ) and /or MRI-detected BME ( intervention group only ) . The primary outcome measures are DAS28 remission ( DAS28 < 2.6 ) and radiographic progression ( Sharp/vdHeijde score ) . Discussion The perspectives , strengths and weaknesses of this study are discussed . This study has been approved by The Regional Scientific Ethical Committees for Southern Denmark , S-20110109 . Dissemination will occur through presentations and publication in international peer- review ed journals . Trial registration The study is registered in http://www . Clinical Trials.gov identifier : NCT01656278 ( 5 July 2012 OBJECTIVE Rheumatoid arthritis ( RA ) is a chronic inflammatory disease that may result in debilitating joint deformities with destruction of bone and cartilage . Inflammation is still considered the pivotal inducer of both components of joint damage . Results of recent animal studies suggested a prominent contribution of osteoclastic bone resorption that could be dissociated from inflammation . RANKL and its natural decoy receptor , osteoprotegerin ( OPG ) , play key roles in osteoclast activation . In a group of patients with early RA not treated with disease-modifying drugs , we tested the hypothesis that osteoclast activation , reflected by the serum OPG : RANKL ratio at baseline , is negatively associated with progression of bone damage , independent of inflammation . METHODS  OPG and RANKL levels  , together with a parameter of  inflammation ( first-year time-averaged  erythrocyte sedimentation rate  [ tESR ] ) , were measured in 92 patients with newly diagnosed early active RA who were participants in a r and omized study . The tESR and the OPG : RANKL ratio were evaluated for the ability to predict 5-year radiographic progression of joint damage . RESULTS The first-year tESR and the OPG : RANKL ratio , as measured at baseline , independently predicted 5-year radiographic progression of joint damage ( both P < or = 0.001 ) . Progression of radiographic damage was greatest in patients with a high tESR and a low OPG : RANKL ratio and was lowest in patients with a low tESR and a high OPG : RANKL ratio . CONCLUSION This study in patients with early untreated RA is the first to confirm the findings in animal models of arthritis , that radiographic progression of the bone component of joint destruction is dependent on both inflammation ( tESR ) and osteoclast activation ( the OPG : RANKL ratio ) OBJECTIVE To describe the longitudinal radiographic course of rheumatoid arthritis ( RA ) , and to identify and quantitate predictors of radiographic progression . METHODS This prospect i ve , longitudinal study of radiographic progression and clinical predictors of RA involved 256 patients with RA who were seen within the first 2 years of disease ( mean 0.77 years ) and were followed up for up to 19 years . Participants underwent a total of 6,278 clinical assessment s  ( mean 24.5 ) and 934 paired radiographs ( mean 3.1 , range 2 - 6 ) . Clinical assessment s at every visit included determination of the erythrocyte sedimentation rate ( ESR ) , grip strength , pain scores , tender joint counts , and anxiety and depression measurements . Regression analyses utilized time-integrated predictors . RESULTS Overall , radiographic progression rates , as measured by the summary Sharp scores , appeared constant over the course of RA . The strongest correlate of progression was the time-integrated ESR ( rho=0.53 ) . This association grew stronger with time . At 0 - 5 years , 5 - 10 years , 10 - 15 years , and 15 - 20 years , correlations were 0.40 , 0.50 , 0.65 , and 0.74 , respectively , and for the period 10 - 20 years , the correlation was 0.67 . In multivariate models , the mean ESR , mean grip strength , rheumatoid factor positivity , and tender joint count were independent predictors of radiographic progression . CONCLUSION Radiographic damage occurs at a constant rate in RA , and is not greater early in RA or reduced later in the course of the illness . Acute-phase reactants are , by far , the strongest determinants of progression
It can be classified according to their configuration , shape , content , and can be described specifically with an anatomical term . “
Rheumatoid arthritis is a chronic inflammatory disease characterized by the development of osseous and cartilaginous damage .
The correct differentiation between a true erosion and other entities — then often called “ pseudoerosions”—is essential to avoid misdiagnosing rheumatoid arthritis and to correctly interpret the progress of the disease .
The aims of this systematic review were as follows : to create a definition and delineation of the term “ pseudoerosion ” , to point out morphological pitfalls in the interpretation of images , and to report on difficulties arising from choosing different imaging modalities .