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ID PMID Title PublicationDate abstract
11409142 Management of rheumatoid arthritis: the historical context. 2001 Jun We review the historical highlights of the management of rheumatoid arthritis (RA). Studies of nonsteroidal antiinflammatory drugs, disease modifying antirheumatic drugs, and biological agents over 5 decades were evaluated and summarized. There is emphasis on drug therapy as it has developed and evolved from empirical relief of symptoms with salicylates to targeted intervention in the immunoinflammatory process with tumor necrosis factor inhibitors. A therapeutic paradigm has been proposed to rationalize the use of the available therapies. If one accepts the thesis that both the acute and chronic consequences of RA are due to persistent misdirected and inadequately controlled inflammation that causes tissue destruction and loss of function, then prolonged complete control of the abnormal inflammatory process is the fundamental first step in the management of all patients with RA. Unfortunately, even with the newest therapeutic options to treat RA, most patients achieve only partial suppression of inflammation and many lose therapeutic benefit after an initial good response. The management of persistent or recurrent rheumatoid inflammation and disability continues to be a challenge. It remains to be determined whether the future addition of more potent specific interventions in the immunoinflammatory process will be able to solve this problem without disarming host defenses against infections and tumors.
11087698 No increased mortality in patients with rheumatoid arthritis: up to 10 years of follow up 2000 Dec OBJECTIVE: To investigate mortality, functional capacity, and prognostic factors for mortality in an inception cohort of patients with recently diagnosed RA followed up for up to 10 years. METHODS: The observed mortality of this inception cohort with recently diagnosed RA, was analysed in relation to the expected mortality, calculated with the aid of life tables of the general population of the Netherlands (matched for age and sex). Functional capacity was measured by the Health Assessment Questionnaire. Prognostic factors for mortality were analysed multivariately by the Cox proportional hazards model. RESULTS: Between January 1985 and April 1997, 622 patients entered the study, and were included in the analysis of mortality. The death rate in the first 10 years of the disease was not significantly different from that of the general population. Fifty five patients from the study group died (16% up to 10 years of follow up). The most commonly reported causes of death were of cardiovascular and respiratory origin. The other causes of death could be classified into cancer, sepsis, amyloidosis, leukaemia, renal insufficiency of unknown cause, perforation of the oesophagus, probably related to the treatment with non-steroidal anti-inflammatory drugs, and pancytopenia during aurothioglucose treatment. Functional capacity improved significantly during the first six years compared with the value at start. Statistically significant predictors for death were age at the start and male sex. CONCLUSIONS: In contrast with earlier studies performed, no excess mortality in the first 10 years of an inception cohort of patients with RA was seen. In addition, the functional capacity was relatively constant during the first six years after an initial improvement from baseline. Age at start and male sex were the only statistically significant predictors for death.
10652643 Amyloid precursors and amyloidosis in rheumatoid arthritis. 1999 Dec Amyloidosis refers to the extracellular accumulation of amyloid fibrils, derived from a circulating precursor, in various tissue and organs. The most common form of amyloidosis worldwide is that which occurs secondary to chronic inflammatory disease, particularly rheumatoid arthritis. The precursor molecule is serum amyloid A (SAA), an acute phase reactant, which can be used as a surrogate marker of inflammation in many diseases. SAA has a number of immunomodulatory roles, can induce chemotaxis and adhesion molecule expression, has cytokine-like properties and can promote the upregulation of metalloproteinases. It enhances the binding of high density lipoprotein to macrophages and thus helps in the delivery of lipids to sites of injury for use in tissue repair. It is thus thought to be an integral part of the disease process. Moreover, elevated levels of SAA over time predispose to secondary amyloidosis. Pathogenic factors underlying this disease are outlined along with guidelines for diagnosis and management.
9445534 [Effectiveness of autologous blood replacement in rheumatoid arthritis surgery--a report o 1997 The management and the resulting effectiveness of a four-step autotransfusion concept, consisting of preoperative autologous blood predeposit, isovolaemic haemodilution, preoperative plasmapheresis and intraoperative autotransfusion in rheumatic patients undergoing planned operations associated with considerable blood loss, are presented. In just one case out of 117 primary total joint replacements of the hip or knee that were retrospectively studied in rheumatic patients suffering from chronic anaemia did a homologous erythrocyte concentrate have to be transfused. A 19-year-old patient suffering from juvenile arthritis who underwent a total knee replacement operation had the lowest haemoglobin and haematocrit levels with a perioperative haemoglobin of 4.2 g/dl and a haematocrit of 12.4%. In 1996, 4,073 autologous transfusions were made by the anaesthetic ward. The autotransfusion concept was established in 1988. At that time 47% of the total blood demand was replaced by autologous transfusion. In 1989 there was an increase to 88%, in 1990 to 94%, and in 1991 to 98%. From 1992 up to 1996 the autologous transfusions covered continuously more than 99% of the total blood demand. It is pointed out, that under normovolaemic conditions the chronic anaemia of these rheumatic patients is a contraindication neither for predeposit nor for intraoperative autotransfusion.
9550954 Is day care equivalent to inpatient care for active rheumatoid arthritis? Randomised contr 1998 Mar 28 OBJECTIVE: To test the clinical equivalence and resource consequences of day care with inpatient care for active rheumatoid arthritis. DESIGN: Randomised controlled clinical trial with integrated cost minimisation economic evaluation. SETTING: Rheumatic diseases unit at a teaching hospital between 1994 and 1996. SUBJECTS: 118 consecutive patients with active rheumatoid arthritis randomised to receive either day care or inpatient care. MAIN OUTCOME MEASURES: Clinical assessments recorded on admission, discharge, and follow up at 12 months comprised: the health assessment questionnaire, Ritchie articular index, erythrocyte sedimentation rate, hospital anxiety and depression scale, and Steinbrocker functional class. Resource estimates were of the direct and indirect costs relating to treatment for rheumatoid arthritis. Secondary outcome measures (health utility) were ascertained by time trade off and with the quality of well being scale. RESULTS: Both groups had improvement in scores on the health assessment questionnaire and Ritchie index and erythrocyte sedimentation rate after hospital treatment (P < 0.0001) but clinical outcome did not differ significantly between the groups either at discharge or follow up. The mean hospital cost per patient for day care, 798 Pounds (95% confidence interval 705 Pounds to 888 Pounds), was lower than for inpatient care, 1253 Pounds (1155 Pounds to 1370 Pounds), but this difference was offset by higher community, travel, and readmission costs. The difference in total cost per patient between day care and inpatient care was small (1789 Pounds (1539 Pounds to 2027 Pounds) v 2021 Pounds (1834 Pounds to 2230 Pounds)). Quantile regression analysis showed a cost difference in favour of day care up to the 50th centile (374 Pounds; 639 Pounds to 109 Pounds). CONCLUSIONS: Day care and inpatient care for patients with uncomplicated active rheumatoid arthritis have equivalent clinical outcome with a small difference in overall resource cost in favour of day care. The choice of management strategy may depend increasingly on convenience, satisfaction, or more comprehensive health measures reflecting the preferences of patients, providers, and service commissioners.
11797101 Dog MHC alleles containing the human RA shared epitope confer susceptibility to canine rhe 2001 Oct To determine whether canine rheumatoid arthritis (CRA) is associated with dog MHC (DLA-DRB1) alleles which contain the QRRAA/RKRAA conserved third hypervariable region (3HVR) sequence, DNA samples were extracted from 61 dogs with clinically diagnosed small-joint polyarthritis and from 425 controls. Breed-matched controls were available for 41 cases. DLA-DRB1 genotypes were identified using molecular typing methods. Phenotype frequencies were compared between cases and controls and odds ratios with 95% confidence intervals calculated. Several DLA-DRB1 alleles were associated with increased risk for CRA: DLA-DRB1*002, DRB1*009, and DRB1*018. This was also observed for the presence of any shared epitope (SE)-bearing allele. The associations with DLA-DRB1*002 and the SE were maintained when only breed-matched cases and controls were compared. This study suggests that a conserved amino acid motif in the 3HVR present in some DRB1 alleles of both dogs and humans is associated with rheumatoid arthritis in both species.
11484100 Flexible hinge toe implant arthroplasty for rheumatoid arthritis of the first metatarsopha 2001 We report the long-term clinical results and survival rate of the implant in flexible hinge toe implant arthroplasty of the first metatarsophalangeal joint, combined with a shortening oblique osteotomy of the metatarsal neck in the lateral toes, in patients with rheumatoid arthritis. Between 1983 and 1990, arthroplasty was performed on 97 feet in 66 patients. Twenty-seven patients died; follow-up information was available for 60 feet in the remaining 39 patients, who were followed for an average of 12 years. Twenty-nine patients (74%) were satisfied with the outcome after surgery, 7 were satisfied but had some pain or recurrent deformities, and 3 were unsatisfied. Radiologically, visible fracture was identified in nine implants. Four implants were removed because of infection (n = 2) or recurrent deformity (n = 2); no implant was removed because silicone synovitis developed. With revision as the endpoint, the implant survival rate was 93% at 10 years, and with radiographic implant fracture as the endpoint, the implant survival rate was 87% at 10 years. Shortening oblique osteotomy of the lateral toes appeared to decrease the rate of implant fracture and should be performed concomitantly with implantation when rheumatoid forefoot deformities are being reconstructed.
10567978 Mortality in rheumatoid arthritis. 1999 Oct Rheumatoid arthritis reduces not only quality but also length of life. In the 14 main studies conducted since 1980, in a total of 13,424 patients, the mean standardized mortality ratio was 1.82 (range, 0.87-3) as compared to the population at large. Life expectancy was shortened by 5 to 10 years in most studies. The diversity of the methods used explains the discrepancies among results. Excess mortality may occur in only some subsets of patients. Both rheumatoid complications and an increase in nonspecific causes of death (e.g., infections) contribute to the excess mortality. Factors predictive of premature death are the same as those predictive of functional impairment. Many unknowns remain about the condition of rheumatoid arthritis patients at the end of their life.
9032386 Spontaneous establishment of an Epstein-Barr virus-infected fibroblast line from the synov 1997 Mar An Epstein-Barr virus (EBV)-infected fibroblast line, designated DSEK, was spontaneously established from synovial tissue of a patient with rheumatoid arthritis (RA). DSEK cells expressed EBV nuclear antigens EBNA-1 and EBNA-2 and latent membrane protein LMP-1. Cell surface markers of DSEK cells were similar to those of EBV-negative fibroblast clones derived from synoviocytes and were negative for lymphocyte and macrophage markers. DSEK cells expressed CD44, CD58, and HLA-DR antigens and spontaneously produced interleukin-10 basic fibroblast growth factor and transforming growth factor beta1. These results indicate that rheumatoid synoviocytes can be a target for EBV infection and suggest that EBV may play a role in the pathogenesis of RA.
9273770 [The rheumatoid patient as back pain patient. Diagnosis and differential diagnosis of sero 1997 Jun 1 Based on an epidemiology study the frequency of back pain in the population was established by forty percent. Otherwise only thirty percent of patients with backache are diagnosed definitely by practitioners. In view of these circumstances the 1991 published diagnosis criteria for spondylarthropathies are a helpful work in definition of spondylarthropathy patients. Furthermore a new described autoantibody specifically for spondylarthropathies seems to be helpful for this diagnosis of these systemic rheumatic diseases.
9340436 [Comparison of myocardial effects of various antirheumatic modalities in patients with rhe 1997 A prospective study was conducted of basic antirheumatic drugs (chrisanolum, myocrisin, ridaura, chlorbutin, D-penicillamine) versus nonspecific antiinflammatory treatment in 127 patients with rheumatoid arthritis (RA). The drugs were compared by their effect on myocarditis. Basic antirheumatic drugs were found much superior to nonsteroid antiinflammatory drugs. The highest response was registered for chrisanolum myocrisin and chlorbutin after 6-12 month continuous treatment. Warning: chrisanolum, myocrisin and ridaura may produce unwanted short-term effects on left ventricular contractility in developing extracardiac complications of aurotherapy.
11688953 Patient survival after total knee arthroplasty. 2001 Oct The authors analyzed the 5-year and 9-year survival in 134 of 165 patients who underwent total knee arthroplasties from 1989 to 1996 in our department. Patients were followed until December 31, 1998, or until the time of death. Diagnoses were rheumatoid arthritis in 81 patients (132 knees) and osteoarthritis in 53 patients (79 knees). The survival of the patients was compared to that of the age- and sex-adjusted general population. Kaplan-Meier survival curves were constructed. Twenty-two patients in the study died before the end of the follow-up. The cumulative 5-year patient survival was 88.7%, and 9-year patient survival was 64.4% for total knee arthroplasty patients. The standardized mortality ratio was 0.11 (95% confidence interval: 0.02-0.40) for the patients with osteoarthritis, and 0.81 (95% confidence interval: 0.52-1.25) for the patients with rheumatoid arthritis. The Cox proportional hazards model showed that the factors of male sex and rheumatoid arthritis were related to a higher mortality rate in the total knee arthroplasty group.
9803986 The population pharmacokinetics of long-term methotrexate in rheumatoid arthritis. 1998 Oct AIMS: Methotrexate is considered by many practitioners to be the agent of choice in the treatment of rheumatoid arthritis. The pharmacokinetics of methotrexate have been reported to exhibit significant intersubject variability. Therefore, this study was undertaken to evaluate the population pharmacokinetics of methotrexate during long-term administration in adults with rheumatoid arthritis. METHODS: Methotrexate pharmacokinetics were evaluated in a 36 month study of 62 adults with rheumatoid arthritis. Patients received oral or intramuscular doses of methotrexate weekly with pharmacokinetic studies performed every 6 months. Data were analyzed with nonlinear mixed effects modeling. RESULTS: Three thousand two hundred and sixty post oral or intramuscular dose serum methotrexate concentrations comprising 425 individual concentration vs time profiles were modeled using NONMEM. Covariates that significantly (P < 0.005) influenced the disposition of methotrexate were age (AGE, years), body weight (BW, kg), creatinine clearance (CL(CR), 1 h(-1)), gender (GEN; 0 = male, 1 = female), dose (DOSE, micromol), and fed vs fasted state (FED; 0 = fasted, 1 = fed). The final model describing the biexponential disposition of methotrexate was clearance(CL, 1 h(-1)) = (0.0810*BW + 0.257*CL(CR))*(1-(0.167*GEN); central volume (Vc, 1) = 0.311*BW; peripheral volume (Vp, 1) = 0.469*BW-0.169*AGE; intercompartmental clearance (Q, 1 h(-1)) = 4.27*(1-0.355*GEN); oral absorption rate constant (ka(p.o.), h(-1)) = 4.70-0.0439*DOSE*(1-0.507*FED); intramuscular absorption rate constant (ka(i.m.), h(-1)) = 0.122*DOSE; relative bioavailability (F) = 93.4%; and oral absorption lag time (LAG(p.o.), min) = 13.5. Pharmacokinetic parameters (%CV) for a typical fasted male subject in this study were CL, 7.341 h(-1) (27%); Vc, 23.51 (28%); Vp, 25.31 (31%); Q, 4.25 1 h(-1) (41%); ka(p.o.), 3.67 h(-1) (77%); and ka(i.m.), 3.09 h(-1) (44%). CONCLUSIONS: The population pharmacokinetics of methotrexate in adults with rheumatoid arthritis were well described by this investigation. Substantial interpatient variability was explained by incorporating patient specific data into regression equations predicting pharmacokinetic parameters.
11808986 Does vascular endothelial growth factor in the rheumatoid synovium predict joint destructi 2001 Dec OBJECTIVE: Synovial angiogenesis is at the epicenter of rheumatoid pannus development and is largely dependent on vascular endothelial growth factor (VEGF). We sought to determine whether the VEGF level in rheumatoid synovial tissue is a marker for disease severity. PATIENTS AND METHODS: Twelve patients with rheumatoid arthritis (RA) underwent a clinical and radiological evaluation at the time of a synovial biopsy done during joint surgery required by RA progression (T1) and, on average, 10 years later (T2). Immunohistochemistry was used to detect and quantitate VEGF in the synovial biopsy taken at T1. RESULTS: VEGF labeling was seen on endothelial cells and macrophages in all 12 synovial biopsies. The amount of endothelial-cell VEGF labeling (assessed semi-quantitatively) was significantly correlated with Larsen score progression during the 10-year follow-up. The amounts of endothelial cell or macrophage VEGF labeling was not correlated with the joint count, radiological stage of the biopsied joint or progression of this stage, Larsen scores at T1 or T2, presence of rheumatoid factor, or presence of extra-articular manifestations. CONCLUSION: Our results suggest that the amount of VEGF in the rheumatoid synovium may be a marker for joint destruction in patients with RA.
11409664 The effectiveness and toxicity of cyclosporin A in rheumatoid arthritis: longitudinal anal 2001 Jun OBJECTIVE: To determine factors associated with response or toxicity to cyclosporin A (CSA) in a population-based inception cohort with rheumatoid arthritis (RA). METHODS: Prospectively collected longitudinal measures including tender joint count (JC), duration of morning stiffness (MS), systolic and diastolic blood pressure (SBP, DBP), and serum creatinine (SCr) were modeled using generalized estimating equations. Survival methods were used to estimate CSA continuation time and its determinants. RESULTS: Of 133 patients (75% female, median RA duration 13 years), 37 discontinued CSA because of ineffectiveness (19) or because of toxicity (18) including increased SCr in 10, hypertension in 4, infections in 3, and gingival hyperplasia in 1. Patients remained on CSA a median of 75 months (95% confidence interval [CI] 38-112). Those receiving concomitant methotrexate (MTX) were more than 4 times as likely to continue on CSA therapy (hazard ratio 0.22, 95% CI 0.10-0.94). A lower final JC was predicted by a longer CSA treatment duration (relative risk [RR] 0.99 per month, 95% CI 0.98-0.99) and concomitant MTX therapy (RR 0.79, 95% CI 0.63-0.99); decreased MS was predicted only by longer CSA treatment duration (reduction of 2.0 minutes per month, 95% CI 1.1-3.0). Each previous disease-modifying antirheumatic drug (DMARD) exposure predicted a rise in SCr (35 micromole/liter, 95% CI 22-48), SBP (7.2 mm Hg, 95% CI 2.7-11.7), and DBP (3.8 mm Hg, 95% CI 3.0-6.4). CONCLUSIONS: Combination CSA/MTX prolongs therapy and reduces JC. Long-term CSA treatment was fairly well tolerated. Previous DMARD use appears to be a determinant for the development of toxicity.
9133933 Late-onset rheumatoid arthritis: is pitting oedema of the hands at onset a good prognostic 1997 Feb This prospective study compares the clinical and radiological outcome of patients with late-onset (age 65 yr and over) rheumatoid arthritis (RA) presenting with and without pitting oedema of the hands (POH). Twenty-two patients with POH (Group 1) were compared with 81 (Group 2) without POH (median age of onset of RA-Group 1: 74.3; Group 2: 73.1; female to male. ratio-Group 1: 1.2:1; Group 2: 2.5:1). The median time between the onset of arthritis and baseline assessment was 3 months. Minimum follow-up was 1 yr (median 2.4). Outcome was defined by (1) the development of erosions of the hands, wrists or feet and (2) the number of patients in remission (clinically inactive disease on two clinic visits 3 months apart with no intervening history of inflammatory joint disease). IgM rheumatoid factor (IgM RF) was less frequent in patients with POH (Group 1:8.2%; Group 2: 43.2%, P < or = 0.05). Logistic regression analysis showed that POH at onset was independent of IgM RF in determining outcome. Patients with POH were less likely to develop erosions [odds ratio (OR) = 0.16, 95% confidence interval (CI) 0.03, 0.89]. Although initial cross-tabulation suggested an increased frequency of remission in Group 1 (Group 1: 90.9%; Group 2: 55.5%, P = 0.02), POH was not found to be a significant predictor using the logistic regression model (OR = 7.42, 95% CI 0.84, 65.7). Patients with IgM RF were more likely to develop erosions (OR = 5.1, 95% CI 1.46, 17.67) and less likely to go into remission (OR = 0.19, 95% CI 0.06, 0.68).
9070253 Superantigen-induced stromelysin production from rheumatoid synovial cells. 1997 Feb 3 Superantigens activate a large number of T cells in a V beta-restricted manner after binding to MHC class II molecules on the antigen presenting cells (APC). Superantigens also activate APC directly by interacting with their ligands, MHC class II molecules. In the present study, we examined the effects of superantigens on matrix metalloproteinases (MMPs) secretion from rheumatoid synovial fibroblasts. We demonstrated that stimulation of interferon (IFN)-gamma-treated synovial fibroblasts with staphylococcal enterotoxin A (SEA) selectively induced the secretion of stromelysin, a neutral MMP, from synovial fibroblasts. Pretreatment of synovial fibroblasts with cycloheximide, an inhibitor of protein synthesis, prevented MMP-3 secretion from rheumatoid synovial cells suggesting that protein synthesis was required for SEA-induced MMP-3 secretion after SEA binding to MHC class II molecules. Our data suggest that in the synovium, bacterial superantigens are potent inducers of stromelysin which plays a critical role in articular destruction observed in inflammatory joint disease.
9329958 Amelioration of collagen-induced arthritis by CD95 (Apo-1/Fas)-ligand gene transfer. 1997 Oct 15 Both rheumatoid arthritis and animal models of autoimmune arthritis are characterized by hyperactivation of synovial cells and hyperplasia of the synovial membrane. The activated synovial cells produce inflammatory cytokines and degradative enzymes that lead to destruction of cartilage and bones. Effective treatment of arthritis may require elimination of most or all activated synovial cells. The death factor Fas/Apo-1 and its ligand (FasL) play pivotal roles in maintaining self-tolerance and immune privilege. Fas is expressed constitutively in most tissues, and is dramatically upregulated at the site of inflammation. In both rheumatoid arthritis and animal models of autoimmune arthritis, high levels of Fas are expressed on activated synovial cells and infiltrating leukocytes in the inflamed joints. Unlike Fas, however, the levels of FasL expressed in the arthritic joints are extremely low, and most activated synovial cells survive despite high levels of Fas expression. To upregulate FasL expression in the arthritic joints, we have generated a recombinant replication-defective adenovirus carrying FasL gene; injection of the FasL virus into inflamed joints conferred high levels of FasL expression, induced apoptosis of synovial cells, and ameliorated collagen-induced arthritis in DBA/1 mice. The Fas-ligand virus also inhibited production of interferon-gamma by collagen-specific T cells. Coadministration of Fas-immunoglobulin fusion protein with the Fas-ligand virus prevented these effects, demonstrating the specificity of the Fas-ligand virus. Thus, FasL gene transfer at the site of inflammation effectively ameliorates autoimmune disease.
9222789 Do new cases of rheumatoid arthritis cluster in time or in space? 1997 Jun OBJECTIVES: To examine for evidence of clustering in time, in space and in space/time in the occurrence of rheumatoid arthritis (RA). SETTING: A population-based incidence register of RA in the East Anglian region of the UK: population size 413,000. SUBJECTS: In all 687 new cases of inflammatory joint disease registered between 1 January 1990 and 31 December 1994 were studied. Population data were obtained from postcode areas by age and sex. ANALYSIS: Time trend analysis was conducted over the first 36 months and observed and expected distributions compared. Spatial clustering was based on comparison of observed distribution using map grid references to random expectation based on simulation. A similar procedure was undertaken for time/space clustering. RESULTS: There was no evidence of a time trend. There was only modest evidence of spatial clustering with non-random distribution observed in one area but there was no evidence of time/space clustering. CONCLUSION: Although a viral aetiology is the strongest candidate for RA, no evidence of a localized event in time was associated with disease development in this population.
9652498 Rheumatoid arthritis: follow-up and response to treatment. 1998 May OBJECTIVE: To assess the role of diagnostic imaging techniques in the identification and follow-up of the anatomical damage induced by the chronic inflammatory process of rheumatoid arthritis (RA) not only to study the natural history of the disease but also and especially to assess the long-term response to disease-modifying anti-rheumatic drugs (DMARD). MATERIALS AND METHODS: The relative literature data were reviewed and compared with our personal experience with different imaging modalities such as conventional radiography (CR), ultrasound (US) and magnetic resonance imaging (MRI). RESULTS: Several radiologic techniques have been used over the years to study articular damage in RA: they describe and quantify the articular damage (semi-quantitative analysis) based on a series of parameters and elementary anatomical lesions which are given a rising score. For its sensitivity in detecting early disease signs and the possibility to express anatomical damage progression quantitatively, Sharp's index is considered the best tool for evaluating RA patients. The close correlation between clinical parameters and the radiologic scores obtained regardless of the method applied led to a new concept of anatomical damage related to the 'radiologic progression of the disease' which is a more precise measure of RA severity than the single isolated radiograph. The progression of radiologic damage in rheumatoid arthritis is expressed as the number or proportion of new eroded joints/year: independent of the index adopted and the terms used to express progression, severe radiologic damage occurs in the early disease stage, involving approximately 2% of the joints within about 1 year, and 13% within 2 years, with an estimated average annual progression of 1.3%. Radiologic techniques evaluate the anatomical damage in the course of RA only with reference to the osseous component of the joint and therefore apply to a disease stage that is largely irreversible. MRI and US detect the soft-tissue damage occurring in the earlier phases and are more likely to respond to early treatment. The former technique appears to be useful to detect soft-tissue damage like synovial pannus, intra- and periarticular and peritendinous effusion, capsuloligamentous articular and tendon changes. Its high sensitivity for minimal bone erosions and chondromalacia has been demonstrated. US allows to demonstrate a wide range of soft-tissue changes of the hand and wrist. Joint-cavity widening, loss of cartilage definition, bone erosions, widening of flexor tendon sheath and tendon structure are also well depicted on ultrasound images. CONCLUSIONS: CR is the central tool in the diagnosis, staging and follow-up of RA patients and in general in the assessment of treatment efficacy; MRI and US are complementary tools.