Objective: To determine the prevalence of large-joint damage and the association with small-joint damage in patients with RA after 8 years of low DAS (≤2.4)-targeted treatment with different treatment strategies. Methods: Radiological data of 290 patients participating in the BeSt study, a randomized trial comparing initial monotherapy and initial combination therapy strategies, were used. Radiographs of large joints were scored using the Larsen score and of the small joints using the Sharp-van der Heijde score. With multivariate logistic regression analysis, an association between total damage of the small joints and of the large joints was investigated.Results: After 8 years of treatment, damage was observed in 12% of shoulders, 10% of elbows, 26% of wrists, 13% of hips, 18% of knees and 7% of the ankles. Damage in one or more large joints was found in 64% of patients, with a median score of 1. No difference was found between initial monotherapy or combination therapy strategies. There was a significant association between damage progression in small joints and damage to one or more large joints (OR 1.02; 95% CI 1.00-1.04).Conclusion: After 8 years of DAS-targeted treatment in early RA patients, large-joint damage was found in 64% of patients and was associated with small-joint damage. Continued DAS-targeted treatment is probably more important in damage suppression than initial treatment strategy. Patients with more damage to hands and feet also have more damage to the large joints.

Joint damage, RA, Treatment
dx.doi.org/10.1093/rheumatology/kes228, hdl.handle.net/1765/89083
Rheumatology (United Kingdom)

Dirven, L, Van Den Broek, M, Kroon, H.M, Grillet, B.A, Han, K.H, Kerstens, P.J.S.M, … Allaart, C.F. (2012). Large-joint damage in patients with early rheumatoid arthritis and its association with treatment strategy and damage of the small joints. Rheumatology (United Kingdom), 51(12), 2262–2268. doi:10.1093/rheumatology/kes228