Have Radiographic Progression Rates in Early Rheumatoid Arthritis Changed? : A Systematic Review and Meta-analysis of Long-term Cohorts

The objectives of this systematic review are to evaluate firstly, all published data on baseline and annual progression rates of radiographic damage from all longitudinal observational cohorts, and secondly, the association of standard clinical and laboratory parameters with long-term radiographic joint damage.MethodsA comprehensive search of the literature from 1975 to 2014, using PubMed, SCOPUS and Cochrane databases, identified a total of 28 studies that investigated long-term radiographic progression, and 41 studies investigating predictors of long-term radiographic progression. This was submitted and approved by PROSPERO in February 2014 (Registration Number: CRD42014007589).ResultsMeta-analysis indicated an overall baseline rate of 2.02%, and a yearly increase of 1.08% of maximum damage. Stratified analysis found that baseline radiographic scores did not differ significantly between cohorts recruiting patient’s pre and post 1990 (2.01% vs. 2.03%; p>0.01), however the annual rate of progression was significantly reduced in the post 1990 cohorts (0.68% vs. 1.50%; p<0.05). High levels of acute phase markers, baseline radiographic damage, anti-CCP and Rheumatoid Factor positivity remain consistently predictive of long-term radiographic joint damage. Conclusions: Critical changes in treatment practices over the last three decades are likely to explain the reduction in the long-term progression of structural joint damage. Acute phase markers and presence of Rheumatoid Factor/anti-CCP are strongly associated with increased radiographic progression.