Can radiographic erosion and joint space narrowing be predicted in early rheumatoid arthritis?

This study evaluated potential predictors of erosions and joint space narrowing (JSN) in patients with early rheumatoid arthritis (RA). The data showed that less JSN progression was seen in postmenopausal, overweight women with RA, and smoking was associated with JSN progression.

RA is an autoimmune disease that is associated with chronic inflammation. Radiography (X-ray images) of the joints) is used to detect early joint damage in patients with RA. Early joint damage includes erosions and cartilage damage. Cartilage damage causes JSN. This leads to stiffness and pain in the joints.

Previous studies have shown that smoking is associated with more radiographic progression in early RA. High body mass index (BMI; a measure of body weight in relation to height) is associated with less radiographic progression. It is unclear whether the link between BMI and joint damage is age-related.

This study included 233 patients with early RA. Patients were assessed at the beginning of the study, at 1 year, and at 5 years. 

86% of patients with early RA showed radiographic progression of joint damage at 5 years. There was an association between a higher erosion score at the beginning of the study and erosion and JSN progression over time. While a higher JSN score at the beginning was associated with JSN progression alone.

Positive rheumatoid factor (RF) levels in the blood strongly predicted erosion and JSN score progression. High erythrocyte sedimentation rate (ESR) predicted erosion and JSN progression. Anti-CCP antibodies, smoking, and high disease activity at the beginning also predicted erosion progression.

Overweight or obesity was associated with lower JSN score progression in women above the age of 51, but not in younger women.

The study showed a reduced risk of JSN progression in older, overweight females and in females with a higher ratio of central body fat.

The sample size for the study was small and radiographic scoring was done by a single individual. Radiographic data on some patients was unavailable at certain times.