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ID PMID Title PublicationDate abstract
11874837 Which patients stop working because of rheumatoid arthritis? Results of five years' follow 2002 Apr OBJECTIVES: To assess the occurrence and prognostic factors for the ability to maintain paid work in patients with rheumatoid arthritis (RA). SETTING: Inception cohort of patients with RA recruited from rheumatology departments in nine NHS Hospital Trusts in England. PATIENTS: All consecutive patients with RA of less than two years' duration, before any second line (disease modifying) drug treatment, and followed up for five years. METHODS: Clinical, laboratory, and radiological assessments, and all treatments were recorded prospectively using a standardised format at presentation and yearly. OUTCOME MEASURES: Changes in, and loss of paid work by five years' follow up. RESULTS: 732 patients completed the five year follow up. 353/721 (49%) were gainfully employed at the onset of RA, 211 (60%) were still working at five years, 104 (29%) stopped because of the disease, and 31 (9%) retired for reasons other than RA. Work disability at five years was more likely in manual workers (odds ratio (OR) 2.3, 95% confidence interval (CI) 1.4 to 3.8) and worse baseline Health Assessment Questionnaire (HAQ>1.5, OR 2.26, 95% CI 1.38 to 3.7). In combination with other baseline variables (erythrocyte sedimentation rate, sex, age of onset, and radiological erosions), employment outcome was predicted in 78% using multivariate analysis. CONCLUSIONS: Nearly half of the patients with RA were in paid employment at onset, work disability was an adverse outcome for a third of these patients by five years, and manual work and high baseline HAQ were important predictors for this. These details are likely to be useful to clinicians, health professionals, and patients in order to plan medical, orthopaedic, and remedial treatments in early RA. Future disease modifying treatments could be compared with this cohort of patients who were treated with conventional second line drugs.
14872482 Impact of shared epitope genotype and ethnicity on erosive disease: a meta-analysis of 3,2 2004 Feb OBJECTIVE: The strongest known genetic association in rheumatoid arthritis (RA) is with HLA-DRB1 alleles that share a similar amino acid sequence, termed the shared epitope (SE). Although many studies have examined the association of the SE with disease severity, the results have been inconsistent, which may reflect the relatively small sample sizes or ethnic differences. The aim of this study was to assess the association of HLA-DRB1 SE alleles and genotype with the development of bony erosions in RA by meta-analysis. METHODS: We identified English-language articles published between January 1, 1987 and June 1, 1999 through Medline, EMBase, and manual searches of 6 relevant journals. Included were studies in which molecular typing of HLA-DRB1 alleles was performed and in which the presence or absence of bony erosions was reported. Data were extracted from the studies, and erosions were coded as present or absent. Authors were contacted for missing information and data on individual patients. RESULTS: A total of 29 studies and 3,240 patients were available for analysis. The summary odds ratios (ORs), when all patients were evaluated as a single group, demonstrated a significant association of the presence of the SE (2 or 1 versus 0 SE alleles) with erosions (OR 2.0; 95% confidence interval [95% CI] 1.8-2.2), although significant heterogeneity was present (P = 0.002). Subgroup analyses demonstrated the important influence of ethnic background. For example, no association of the SE with erosions was demonstrated in Greeks (OR 0.8 [95% CI 0.2-1.5]). In contrast, there was a striking dose-dependent relationship in southern European Caucasians and Asians, with ORs as high as 6.2 and 5.4, respectively, in patients with 2 SE alleles. Although our ability to assess the relationship between SE genotype and erosions was limited, particular importance of the DRB1*0401 SE allele was suggested in an analysis restricted to northern European Caucasians. CONCLUSION: The SE is associated with the development of erosive disease in many ethnic groups; however, striking exceptions exist. These variations may be due to allele differences between populations, such as the frequency of DRB1*0401 among different ethnic groups. Further study to better understand the genetic and environmental differences between these populations may provide insight into mechanisms that influence the clinical expression of RA.
15616758 Assessment of fracture risk. 2005 Jun The diagnosis of osteoporosis is based on the measurement of bone mineral density (BMD). There are a number of clinical risk factors that provide information on fracture risk over and above that given by BMD. The assessment of fracture risk thus needs to be distinguished from diagnosis to take account of the independent value of the clinical risk factors. These include age, a prior fragility fracture, a parental history of hip fracture, smoking, use of systemic corticosteroids, excess alcohol intake and rheumatoid arthritis. The independent contribution of these risk factors can be integrated by the calculation of fracture probability with or without the use of BMD. Treatment can then be offered to those identified to have a fracture probability greater than an intervention threshold.
15794197 TGF-beta1 polymorphism determines the progression of joint damage in rheumatoid arthritis. 2004 OBJECTIVE: To determine whether transforming growth factor-beta1 (TGF-beta1) polymorphisms are associated with susceptibility to rheumatoid arthritis (RA) and to analyse whether they can affect the progression of radiographic severity. METHODS: A total of 143 RA patients and 148 healthy unrelated controls were tested for the TGF-beta1 polymorphisms using polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP). RESULTS: The TGF-beta1 polymorphisms were not associated with susceptibility to RA, although there was a trend that -509C/T and the 869T/C polymorphisms were associated with RA in the male population. The progression of radiographic severity, which was defined by a modified Sharp score plotted against disease duration, was significantly faster in the carrier of T allele at the -509 (p=0.048). CONCLUSION: Our data support the hypothesis that TGF-beta1 polymorphism may determine the progression of joint destruction in RA.
12542898 Aspirin and sodium salicylate inhibit proliferation and induce apoptosis in rheumatoid syn 2002 Dec Aspirin has been reported to induce apoptosis in a variety of cell lines. In this study, we examined whether aspirin and sodium salicylate inhibit cell growth and induce apoptosis in rheumatoid synovial cells. Synovial cells were obtained from patients with rheumatoid arthritis, and the cells were treated with aspirin or sodium salicylate (0.1-10 mM) for 24 h. Cell proliferation and viability were assessed by 5-bromo-2'-deoxyuridine incorporation and by 4-[3-(4-iodophenyl)-2-(4-nitrophenyl)-2H-5-tetrazolio]-1,3-benzene disulfonate (WST-1) assay, respectively. The apoptosis of synovial cells was identified by DNA fragmentation assay and terminal deoxynucleotidyl transferase-mediated dUTP nick end labelling (TUNEL) assay. Aspirin and sodium salicylate suppressed the proliferation (IC50 (concentration causing 50% inhibition of cell proliferation): 2.1 and 1.2 mM, respectively) and reduced the viability (IC50: 2.0 and 1.4 mM, respectively) of synovial cells in a concentration-dependent manner at 0.3-10 mM. Furthermore, they induced DNA fragmentation and increased the number of TUNEL-positive synovial cells. These results suggest that aspirin and sodium salicylate can inhibit the proliferation of rheumatoid synovial cells through induction of apoptosis.
12841616 Technique of intramedullary fixation for arthrodesis of the wrist in rheumatoid arthritis. 2003 We did 18 arthrodeses of the wrist in 16 patients with rheumatoid arthritis using an intramedullary fixation technique. There were 15 women and one man, whose ages at operation ranged from 47 to 71 years (mean 58). Follow up ranged from 13 to 68 months (mean 27). The operative technique consists of a combination of intramedullary placement of two Kirschner (K)-wires and an autogenous bone graft. At follow up bony union was apparent in all cases. K-wires came out of the metacarpal joints in two cases. Paraesthesiae in the median nerve distribution occurred in two cases which both recovered within three months.
15648707 The prevalence and management of hyperglycaemia in patients with rheumatoid arthritis on c 2004 Nov BACKGROUND AND AIMS: Corticosteroids are commonly used in the treatment of RA. Hyperglycaemia resulting from corticosteroid use can lead to problems, particularly in those with impaired glucose tolerance and diabetes mellitus. We have examined how rheumatology clinics monitored and managed hyperglycaemia at base line and during treatment of patients with rheumatoid arthritis on corticosteroids. METHODS: Case notes of 102 patients with established RA, on long-term steroids were reviewed. We recorded a) blood glucose level at base line and whilst on steroids b) when and whether hyperglycaemia was addressed. RESULTS: There were 24 males and 78 females, with mean age of 62 +/- 15 years. Patients were on corticosteroids for a median duration of 24 months. Seventy-five per cent of patients were treated with oral prednisolone, the rest, except one patient on deflazacort, were on methylprednisolone. Blood glucose was measured at baseline in 97% of patients with 37% and 38% being monitored at three months and six months respectively and 36% annually thereafter. Nine patients (8.8%) developed diabetes mellitus during treatment, but one patient was detected and managed. There were six patients with existing diabetes mellitus in whom glycaemic control worsened between three to six months, but only one patient had treatment adjusted. CONCLUSIONS AND RECOMMENDATIONS: Physicians need to be aware that corticosteroids can increase blood glucose, worsen pre-existing diabetes and predispose to diabetes mellitus. Patients on long-term corticosteroids should be monitored at regular intervals as corticosteroid induced glycaemic excursions may lead to the development of diabetes mellitus and increased coronary risk.
12215867 Effect of methotrexate on pulmonary function in patients with rheumatoid arthritis--a pros 2002 Sep If given in high doses, methotrexate (MTX), a folate antagonist, could cause pulmonary complications. To evaluate the pulmonary effects of low-dose methotrexate, 55 newly diagnosed patients with rheumatoid arthritis (RA) prescribed with MTX were studied prospectively. A significant reduction in percent predicted values of forced expiratory volume (FEV(1)), forced vital capacity (FVC), total lung capacity (TLC), and functional residual capacity (FRC) was observed after 2 years of MTX treatment. A significant increase in the FEV(1):FVC ratio was also observed. In comparison to the normal annual decline in healthy adults, the actual reduction in observed values in the patients was significantly greater (3.2, 6.3, and 6.7 times normal for FEV(1), FVC, and TLC, respectively). PaO(2) and oxygen saturation showed marginal but significant improvement. It was concluded that low-dose MTX treatment in RA might cause an accelerated decline in lung function. Therefore, periodic monitoring of pulmonary function among RA patients started on MTX could be necessary.
12181822 [Differential diagnosis of neutropenia in large granulated lymphocyte syndrome and in rheu 2002 The paper reports a case of leukemia from large granulated lymphocytes (LGL) in a patient with rheumatoid arthritis and neutropenia, describes current aspects of this leukemia diagnosis including morphological, immunological and molecular-genetic methods, demonstrates other variants of neutropenia development in rheumatoid arthritis.
15509136 Efficacy and tolerability of a combination of Lyprinol and high concentrations of EPA and 2004 May This 12-week drug-monitoring study was conducted to evaluate the efficacy of Sanhelios Mussel Lyprinol Lipid Complex on 50 adult men and women with inflammatory rheumatoid arthritis. A total of 34 patients required drug therapy before and during the study. By the end of the study, 21 (62%) patients were able to reduce their dosage and 13 were able to terminate drug therapy. At the end of the treatment period, 38% were regarded symptom free, and the number of patients with severe pain decreased significantly from 60% at baseline to 25% at the completion of the trial. A significant effect was observed for each investigated parameter. The special combination of Lyprinol and omega-3 fatty acids was generally very well tolerated, with only one, nonserious adverse event (mild nausea) reported. This dietary supplement may therefore be considered an effective and well-tolerated component of treatment regimens for inflammatory rheumatoid arthritis.
15940560 Ultrasonographic evaluation of tendons and enthesal sites in rheumatoid arthritis: compari 2005 Jun The objective of this study was to determine tendon involvements and enthesal abnormalities in patients with rheumatoid arthritis (RA) using high-resolution ultrasonographic images and to compare the findings with those seen in patients with ankylosing spondylitis (AS) and healthy controls. A total of 24 patients with RA, 18 with AS, and 20 healthy controls matched by age and body mass index (BMI) were included in the study. All of the patients and controls underwent clinical and ultrasonographic examinations of both lower limbs at five enthesal sites (superior and inferior pole of the patella, tibial tuberosity, Achilles tendon, and plantar aponeurosis) and both upper limbs at two tendon sites (tendons of m. biceps brachii and supraspinatus at the shoulder). High-resolution ultrasonographic examinations were performed to detect bursitis, structure thickness, bony erosion, and enthesophyte. An ultrasonographic score of lower limb enthesitis was calculated using the Glasgow Ultrasound Enthesitis Scoring System (GUESS) in all patients. Tendon involvements and enthesal abnormalities were found significantly more often in the RA group than in controls (p<0.05 to <0.001), but were not found to be different from the AS group (p>0.05). On clinical examination 67 of 336 (19.9%) tendon and enthesal sites were abnormal and on ultrasonographic examination 130 of 336 (38.2%) sites were abnormal in RA patients. The most frequently affected enthesal sites in the lower limbs were suprapatellar, infrapatellar, and Achilles tendon in both the RA and AS groups. The tibial tuberosity was less affected in both groups, and involvement of the plantar aponeurosis was not different from the controls. A statistically significant correlation was found between the Ritchie articular index and GUESS (r=0.578, p=0.008). Tendon involvements and enthesal abnormalities in RA patients were found more often than had been estimated. Further studies are required to validate our results.
15648784 Associations between acute phase reactant levels and disease activity score (DAS28) in pat 2004 Autumn Serum levels of acute phase reactants (APR) were measured in patients with rheumatoid arthritis (RA) and the correlations of these parameters with the disease activity score (DAS28) were investigated. The study included 47 patients with RA and 50 healthy controls. Laboratory tests included erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP), haptoglobin (Hp), ferritin, and plasma fibrinogen. Disease activity was assessed using the DAS28 score. The means (+/- SD) of ESR, CRP, Hp, ferritin, and fibrinogen levels were respectively 36.0 +/- 23.5 mm/hr, 2.4 +/- 1.9 mg/dl, 121.3 +/- 34.2 mg/dl, 67.7 +/- 36.2 ng/ml, and 371.2 +/- 96.0 mg/dl in the patients with RA, vs 16.4 +/- 11.3 mm/hr, 0.4 +/- 0.3 mg/dl, 104.0 +/- 35.3 mg/dl, 50.9 +/- 23 ng/ml, and 332.2 +/- 58.5 mg/dl in the controls. All of the APR levels were significantly higher in patients vs controls (p < 0.001 for ESR and CRP; p < 0.05 for Hp, ferritin, and fibrinogen). There were significant correlations between serum APR levels and disease activity based on DAS28 score in RA patients (for CRP, r = 0.650, p <0.01; for Hp, r = 0.331, p < 0.05; for ferritin, r = 0.299, p < 0.05; for fibrinogen, r = 0.373, p < 0.01). This study indicates that serum CRP, among the various ARP tests, is the most useful biochemical marker for evaluating the disease activity of patients with RA.
15290732 Infliximab dose and clinical status: results of 2 studies in 1642 patients with rheumatoid 2004 Aug OBJECTIVE: Infliximab is an effective anti-tumor necrosis factor (TNF) agent widely used in the treatment of rheumatoid arthritis (RA). Initially recommended at a dose of 3 mg/kg, subsequent label revisions allowed doses up to 10 mg/kg or at 4-week intervals rather than the originally suggested 8-week intervals, if clinically indicated. The doses used have implications for efficacy and costs, but no data exist for actual dose used in the US. This study evaluates the dosage and rates of increase in infliximab-treated patients with RA. METHODS: Study 1: Review of patient charts and infusion records for 394 RA patients from 2 large rheumatology practices comprising 15 rheumatologists in Dallas, Texas. Study 2: Survey of 1324 RA patients using infliximab participating in a longitudinal study of RA outcomes. Patients completed a detailed questionnaire about clinical status and infliximab use. RESULTS: The results of the 2 studies were similar: the average infliximab dose was 5 mg/kg, increasing most rapidly until the end of the first years, after which the increase was slowed. Increases > 3 mg/kg occurred in 61% of patients in Study 1 and 56% in Study 2. The 8-week treatment interval was almost universally used, and more than 95% of infusions occurred in this interval. The most common reason for increase in dose was insufficient response. Among patients who completed 4 infusions, 75% remained on therapy at 2 years after infliximab start. The average improvement in Health Assessment Questionnaire disability score was 0.28. CONCLUSION: Infliximab dose increases are common, particularly during the first year of treatment. The average dose is 5 mg/kg. Seventy-five percent of patients continue using infliximab 2 years after treatment onset.
15252210 Fall-related risk factors and osteoporosis in women with rheumatoid arthritis. 2004 Oct BACKGROUND: Rheumatoid arthritis (RA) is associated with an increased risk of osteoporotic fractures. Whilst numerous studies have demonstrated low bone density in RA, few studies have examined the risk of falling, which is another major contributor to the pathogenesis of fractures (particularly hip fractures). OBJECTIVES: The aim of this study was to see if fall risk is increased in women with RA, define high-risk subgroups, and determine what proportion of women have increased risk of hip fracture due to osteoporosis and due to increased fall risk. METHODS: We performed a case-control study of older women with RA (n = 103) compared with women without RA referred for open access bone densitometry (n = 203). We measured bone density using dual-energy X-ray absorptiometry and fall risk factors (visual acuity, ability to perform standups, and heel-toe walking). RESULTS: More women with RA gave a history of a previous fall compared with controls (54 vs 44%), although this was just short of being statistically significant (difference 10%, 95% CI -2 to 22). Women with RA were more likely to have abnormal heel-toe walking and inability to perform standups compared with controls (P<0.001); however, visual acuity was similar between cases and controls. Femoral neck osteoporosis was found in 31% and increased fall risk in 68% of women with RA. Women with RA who underperformed in heel-toe walking and were unable to do standups had significantly higher ESR, Health Assessment Questionnaire score and tender joint count. RA symptoms/signs localized to the knees and ankles were more likely to be associated with the presence of fall risk factors. CONCLUSIONS: Fall-related risk factors predictive of hip fracture are common in women with RA. Fall risk needs to be considered when RA patients are being treated for osteoporosis and further work needs to be done to help reduce the risk of falling and fracture in women with RA.
12228159 Mortality in patients with rheumatoid arthritis treated actively from the time of diagnosi 2002 Oct OBJECTIVES: To evaluate the mortality rates among patients with early rheumatoid arthritis (RA) treated actively according to the "sawtooth" strategy. METHODS: The study included 150 early, disease modifying antirheumatic drug (DMARD) naive patients with RA from two patient cohorts. The first cohort was assembled between 1986 and 1989 (87 patients, aged 19-65 years at onset) and the second between 1991 and 1993 (63 patients, aged 27-83 years at onset). The mean duration of symptoms at the time of diagnosis was 7.1 months (range 2-24). The clinical data and the use of DMARDs were systematically recorded. The causes of death were obtained from death certificates and medical records, if available. The data were collected up to 1 November 2000. RESULTS: During a follow up time of 7-14 years, 24 patients died. The standardised mortality ratio was not increased (0.93 in the first cohort and 1.62 in the second cohort). Age adjusted mortality rates did not differ statistically significantly between the two patient cohorts. The causes of death included malignancy (8 patients); cardiovascular diseases (10); respiratory disease (4), including two patients with pneumonia; sepsis (one); and RA (one). High inflammatory activity, disease activity, and poor functional ability at study entry, and the presence of extra-articular features during the follow up were more common among the patients who had died. CONCLUSIONS: No statistically significant increase in mortality rates was seen in these actively treated early RA cohorts during the follow up. High disease activity at the onset and the development of extra-articular features seem to be associated with mortality.
15280570 Rheumatoid arthritis is already expensive during the first year of the disease (the Swedis 2004 Nov OBJECTIVE: To calculate direct and indirect costs in early rheumatoid arthritis (RA) and to characterize patients generating high and low costs respectively. METHODS: Two hundred and ninety-seven patients with recent-onset (< or = 12 months) RA were recruited. Clinical/laboratory data and 'health assessment questionnaire' (HAQ) were registered at inclusion and after 3, 6 and 12 months. After 6 and 12 months, the patients completed a questionnaire concerning health-care utilization and days lost from work. A cut-off point for direct costs was set at 34,000 Swedish kronor (euro3675) defining one-third of the patients as a high-cost group and two-thirds as low-cost group. Indirect costs were calculated for patients aged <65 yr. RESULTS: Two hundred and eleven patients completed the HAQ on both occasions. Indirect costs exceeded direct costs by a factor of 2.3. Sixty three per cent experienced work disability during the first year and were identified as the 'high-indirect-cost group'. Indirect costs accounted for >70% of total costs. Direct costs included ambulatory health care (76%), hospitalization (12%) and medication (9%). Men aged > or = 65 yr had low costs compared with younger men and women of all ages. In multiple logistic regression tests, HAQ, high levels of IgM rheumatoid factor (IgM RF) and poor hand function increased the odds of entering the high-direct-cost group, and poor hand function and pain increased the odds of entering the high-indirect-cost group. CONCLUSIONS: Substantial costs were incurred during the first year after diagnosis of early RA, mainly due to work disability. Indirect costs were two to three times higher than direct costs. High levels of IgM RF, high HAQ score, poor hand function and pain increased the odds of entering high-cost groups.
14626625 High diagnostic performance of ELISA detection of antibodies to citrullinated antigens in 2003 OBJECTIVE: We investigated the rheumatoid arthritis (RA) diagnostic performances of anti-cyclic citrullinated peptide antibody (anti-CCP) and antifilaggrin antibody (AFA) in comparison with RF and matrix metalloproteinase-3 (MMP-3). METHODS: We used a second generation enzyme-linked immunosorbent assay (ELISA) kit for the detection of anti-CCP. We constructed recombinant human filaggrin, which was citrullinated in vitro by human peptidylarginine deiminase, and subsequently used it as the coating antigen for AFA-ELISA. A total of 549 RA patients and 208 other rheumatic disease patients were included in the study. RESULTS: The specificities of anti-CCP (88.9%) and AFA (94.7%) were superior to those of RF (81.7%) and MMP-3 (49.5%). The sensitivity of anti-CCP (87.6%) was superior to all others. However, the sensitivity of AFA (68.7%) was inferior to those of RF (69.8%) and MMP-3 (75.7%). Furthermore, receiver operating characteristic curves of anti-CCP and AFA passed closer to the upper left corner than those of RF and MMP-3, and the areas under the curves (AUC) of AFA and anti-CCP were significantly larger. In addition, the AUC of anti-CCP was significantly larger than that of AFA. CONCLUSION: ELISA detection of antibodies to citrullinated antigens, especially a second generation anti-CCP, showed higher discriminative ability than other assays, including RF, and would be useful to aid the diagnosis of RA in clinical practice.
14648089 [Imaging beyond conventional radiography: mini arthroscopy, duplex ultrasonography and pos 2003 Imaging procedures, such as ultrasound and magnetic resonance imaging have broadened the diagnostic spectrum by "visualization" of pathomorphologic changes in rheumatic diseases. The advantages of these techniques are sectional imaging and three dimensional illustration, which enhance the exact detection of inflammatory soft tissue alterations and the sensitive and early detection of bony changes. Most current techniques and methods such as mini arthroscopy, color and power Doppler ultrasonography and positron emission tomography (PET) complete the set of diagnostic tools for rheumatologists, when other diagnostics reach their limits. Doppler ultrasonography and PET detect and assess inflammatory changes of systemic diseases locally and on the whole, which were not visible by standard diagnostic procedures. Mini arthroscopy furnishes, besides the direct evaluation of the joint, access to the pathomorphologic substrate itself with the opportunity of tissue sampling and further molecular biological analysis. These new diagnostic techniques open a widespread goal for rheumatologists in terms of etiopathogenesis, early diagnosis and monitoring of inflammatory rheumatic diseases.
15547810 High-frequency hearing loss and middle ear involvement in rheumatoid arthritis. 2004 Nov PURPOSE: We aimed to evaluate the possible changes in the middle ears of patients with rheumatoid arthritis (RA) and to measure their hearing functions by eleven different test frequencies including standard and high frequencies. MATERIALS AND METHODS: The study group was comprised of 74 patients with RA. The control group was comprised of 45 healthy subjects. We performed speech test, tympanometry, acoustic reflex test, and standard and high-frequency pure tone audiometric tests in the study and the control groups. RESULTS: It was observed that significant increases in the thresholds of pure tones in all test frequencies for the study group versus the controls (P <.0001). In terms of the duration of the disease, hearing loss of the patients with disease duration of 1 to 5 years was higher than that of the controls and exceeded beyond the level of 20 dB especially in high frequencies starting from 10,000 Hz. In patients with disease duration of 6 to 10 years, the beginning point for hearing loss was 4,000 Hz. The patients with disease duration of 11 to 15 years and of above 16 years had high hearing thresholds in all frequencies. We found normal pressure in the middle ears of the study and the control groups. CONCLUSION: Sensorineural type hearing loss developed in patients with RA especially in high frequencies. We also determined a diminished compliance in the middle ears of those patients, but this was not in a level of a conducting type hearing loss.
12632412 Computerized measurement of magnetic resonance imaging erosion volumes in patients with rh 2003 Mar OBJECTIVE: One of the major aims of therapy in rheumatoid arthritis (RA) is to prevent erosive disease and subsequent disability. One of the important goals of therapy assessment must therefore be the accurate measurement of damage progression. We undertook this study to assess the feasibility, reliability, and validity of measuring magnetic resonance imaging (MRI) erosion volumes and synovial volumes in the wrists of RA patients with the use of a semiautomated computerized method. METHODS: Twelve subjects with seropositive RA were chosen to reflect a spectrum of RA severity as determined by the clinical Joint Alignment and Motion (JAM) Scale. MRI of the dominant wrist was performed at the same time of day at baseline and at 48 hours. Images were transferred to a workstation. Erosion volumes and synovial volumes were measured on the coronal images using OSIRIS imaging software. All images were reread in random order at 72 hours by 1 observer. The results were compared with erosion scores and global synovitis scores obtained by the same observer using the Outcome Measures in Rheumatology Clinical Trials MRI RA scoring system. Radiographs were performed at baseline and were read on 2 occasions by 1 observer using the Scott modification of the Larsen method. RESULTS: Total erosion volume per subject ranged from 0 cm(3) to 4.7 cm(3). The total synovial membrane volume per subject ranged from 0.1 mm(3) to 12.1 cm(3). Intraclass correlation coefficients for erosion volumes and synovial volumes demonstrated excellent intraobserver reliability and interoccasion reliability. There was a strong positive correlation between the total erosion volume and the total erosion score. The correlation between the synovial volumes and synovitis score was less favorable (r = 0.53-0.86). Positive correlations were demonstrated between the erosion volumes, the JAM score, and the modified Larsen scores. No significant correlation was demonstrated between the erythrocyte sedimentation rate, C-reactive protein level, swollen joint count, tender joint count, or the Disease Activity Score in 28 swollen and 28 tender joints and the synovial volumes or synovitis scores. CONCLUSION: This study is the first to demonstrate the feasibility, reliability, and validity of computerized MRI erosion volume measurements in the wrists of RA patients. The method will require further evaluation in terms of interobserver reliability, with examination of responsiveness in longitudinal studies, but the method demonstrates excellent interoccasion and intraobserver reliability and compares favorably with existing RA clinical outcome measures. Synovial volume measurements demonstrated good intraobserver reliability and appeared to be more responsive to synovial change over a 48-hour period in this group of patients.