Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Clinical Rather Than Serologic Measures of Inflammation Determine Radiographic Progression in Rheumatoid Arthritis (RA).

Aletaha1,  Daniel, Smolen2,  Josef S.

Medical University of Vienna, Austria
Medical University of Vienna and Hietzing Hospital, Vienna, Austria


Disease activity in RA can be measured clinically by assessing joint inflammation, typically swollen joint counts (SJC), or systemically by evaluating the acute phase reactants, typically C-reactive protein (CRP). It has been suggested that both SJC and CRP contribute to progression of joint damage1;2. However, since these measures are interrelated, it is not sufficiently clear, which of them is of primary relevance in driving radiographic changes. We aimed to determine the contribution of SJC and CRP to joint damage progression.


We evaluated data from methotrexate (MTX) monotherapy arms of recent randomized controlled clinical trials kindly provided by the respective sponsors (ASPIRE, ERA, Leflunomide, PREMIER, TEMPO). We pooled patients with complete clinical and radiographic data at baseline and 6, 9 and 12 months (n=871). In these patients, we determined the average SJC and average CRP levels from 6–12 months. We then dichotomised both variables into active and not active, where non active was defined as a mean SJC of <1 joint, or a mean CRP of <1mg/dL. Radiographic progression was calculated based on the baseline and 12 months Sharp score readings. We cross-tabulated the mean radiographic progression in 2×2 tables according to activity/non activity of the two variables, SJC and CRP. We assessed the differences using the Wilcoxon two sample test.


As shown in the Table, progression of joint damage in patients with mean CRP>=1 was higher if SJC were also active, and vice versa. If there was no joint activity (SJC<1), radiographic progression was unaffected by CRP status. However, if there was no serologic activity (CRP<1mg/dL), SJC status still determined radiographic progression.

Table. Radiographic progression ± standard deviation (n) in accordance to SJC/CRP activity status.

 CRP activeCRP non active 
SJC active4.6 ± 16.4 (n = 259)2.0 ± 5.9 (n = 477)p < 0.0001
SJC non active0.9 ± 5.9 (n = 24)0.7 ± 4.4 (n = 111)p = 0.146
p = 0.015p = 0.005  


Joint swelling rather than CRP contributes to progression of joint damage in RA.

Acknowledgement. We thank Abbott, Amgen, Centocor, Sanofi-Aventis and Pfizer-Wyeth for kindly providing us with data of their clinical trials and Farideh Alasti for expert statistical support.

(1)van Leeuwen, MA, et al.J Rheumatol 1994; 21:425-429.

(2)Smolen, JS, et al.Arthritis Rheum 2006; 54:702-710.

To cite this abstract, please use the following information:
Aletaha, Daniel, Smolen, Josef S.; Clinical Rather Than Serologic Measures of Inflammation Determine Radiographic Progression in Rheumatoid Arthritis (RA). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2258
DOI: 10.1002/art.30021

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