Background/Purpose: Radiographs of hands and feet represent an objective outcome measure of rheumatoid arthritis (RA). Joint damage is a result of cumulative disease activity over years. Unlike other clinical measures, radiographic damage is caused mainly by disease inflammatory activity. Therefore, radiographs provide a proper measure to analyze outcomes of RA over a long term. Our purpose was to analyze radiographic remission of patients with early RA at ten years after diagnosis in a real life setting.

Methods: All 1046 patients who were diagnosed with RA in 1997–2005 at a single rheumatology center were scheduled for a ten year follow-up with radiographs of hands and feet at years 0, 2, 5, and 10. Larsen score (0 -100) was employed including MCPs, wrists and 2-5 MTP joints. Radiographic remission was defined as no new erosions and no worsening of erosions between the baseline (at diagnosis), and ten years. Proportion of patients with radiographic remission/no remission ten years after diagnosis was compared in patients with a new diagnosis of RA in 1997-99, 2000-02, and 2003-05.

Results: Among 1046 patients (66% women, mean age 58, 60% seropositive, 13% with erosions at baseline), 743 patients (70% women, mean age 54, 65% seropositive, 12% with erosions at baseline) were seen at their 10-year follow-up visit. Among 480 seropositive patients, the median (IQR) progression of Larsen score was 3(0, 8) and in 263 seronegative patients 0(0, 2). Radiographic remission was met at the 10-year follow up visit by 31%, 40%, and 56% of seropositive patients who had the diagnosis in 1997-99, 2000-02, and 2003-05 (Figure 1); p<0.001. In seronegative patients, the figures were 75%, 79%, and 83%, respectively. Over ten years, anti-rheumatic medications included MTX in 79%, 84%, and 90% of the patients diagnosed in 1997-99, 2000-02, and 2003-05, subcutaneous MTX in 13%, 24%, and 25%, SSZ in 82%, 83%, and 72%, HCQ in 61%, 73%, and 76%,  LEF in 13%, 16%, and 14%,  im gold in 19%, 11% and 5%, Pred in 63%, 80%, and 82%, and biologic agents in 10%, 16%, and 19% of the patients, respectively. Mortality (a total of 15% of women and 30% of men died over 10 years) was the main reason for missing data.

Conclusion: Proportion of patients who meet radiographic remission at ten years after diagnosis of early RA is increasing over the recent years. A majority of patients with seropositive RA who were seen at the 10-year control in 2013-15 met radiographic remission (Figure 1). Over the observation period, the use of MTX, sc MTX, HCQ, Pred and biologics increased, and the use of SSZ and im gold declined. Figure 1. Proportion of patients with radiographic remission/no remission, ten years after diagnosis of early seropositive RA.