Prediction of radiographic progression of rheumatoid arthritis

Authors: K. Pavelka;  J. Gatterová
Authors‘ workplace: Revmatologický ústav Praha
Published in: Čes. Revmatol., 18, 2010, No. 1, p. 19-25.
Category: Overview Reports


Progression in structural changes in rheumatoid arthritis leads to a simultaneous decrease in functional abilities and the quality of life of a patient. Therefore it is of great importance to thoroughly evaluate the disease, and use such therapeutic approaches which lead to slowing or a complete cessation of radiographic progression. In the introduction, the authors discuss alternative methods of evaluation of structural progression of RA. The Sharp score (van der Heijde or Gennant modification) still represents the golden standard for the use in clinical randomised trials and observational studies. Furthermore, the authors present two models of risk evaluation of rapid radiographic progression (RRP). The borderline value for RRP was chosen as > 5 units of the Sharp score year. The first model was derived from ATTRACT and ASPIRE studies, and the second one evolved from the BeST study. It is a visual matrix model enabling an evaluation of an individual patient’s risk for RRP using a combination of various risk factors of progression. Based on the percentage value in the RRP risk, appropriate level of aggressive treatment is selected – including, for instance, an initial combination therapy with a biological agent in patients with a high RRP risk, and, on the contrary, a less intensive treatment with a synthetic DMARD monotherapy in patients with a lower risk. Persisting high activity, rheumatoid factors, anti-CCP antibodies or their combination, and high titers of acute phase reactants belong to the most significant risk factors for RRP. This proposed model will have to be tested in further prospective studies in various populations with RA.

Key words:
rheumatoid arthritis, rapid radiographic progression, Sharp score, anti-TNF therapy


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Dermatology & STDs Paediatric rheumatology Rheumatology
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