Información del artículo
Resumen
La artritis reumatoide (AR) se caracteriza por una inflamación crónica de las articulaciones que conduce a la destrucción del cartílago y el hueso. La radiología simple es el método estándar para evaluar la progresión del daño structural y para establecer la eficacia de los nuevos fármacos antirreumáticos modificadores de la enfermedad (FAME). Debido a la importancia de la progresión radiológica en la determinación de resultados a largo plazo sería deseable disponer de un método estandarizado y sistemático para evaluar y cuantificar la progresión del daño radiológico causado por la AR. Presentamos una revisión exhaustiva de radiografía simple en la AR que incluye: los diversos métodos de evaluación radiológica y sus desventajas, la metodología de lectura y las pautas para la presentación de resultados, los principales ensayos clínicos que evalúan la progresión de la enfermedad y la eficacia de los diferentes tratamientos y la hipótesis de reparación del daño estructural.
Palabras clave:
Artritis reumatoide
Radiografía simple
Progresión radiológica
Abstract
Rheumatoid arthritis (RA) is characterized by a chronic inflammation of the joints which leads to the destruction of cartilage and bone. Plain film radiography is the standard method for evaluating disease progression and for establishing the efficacy of new disease modifying antirheumatic drugs (DMARD). Because of the importance of radiographic progression in determining long term outcomes, a standarized, systematic method to evaluate and quantify the amount and progression of radiographic damage caused by RA is desirable. An exhaustive review of the plain radiology in RA is presented and include: the different radiographic scoring methods and their disadvantages, the methods of reading films and the guidelines for presentation of results, the main clinical trials that evaluate disease progression and the efficacy of the different agents in the treatment of RA and the hypothesis that repair of structural damage can occurs.
Key words:
Reumathoid arthritis
Plain film radiography
Radiographic progression
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Bibliografía
[1.]
D. Van der Heijde.
Radiographic imaging: the “gold standard” for assessment of disease progression in rheumatoid arthritis.
Rheumatology, 39 (2000), pp. 9-16
[2.]
D. Van der Heijde.
Structural damage in rheumatoid arthritis as visualized through radiographs.
Arthritis Res, 4 (2002), pp. S29-S33
[3.]
P.A. Ory.
Interpreting radiographic data in rheumatoid arthritis.
Ann Rheum Dis, 62 (2003), pp. 597-604
[4.]
J.H. Brown, S.A. Deluca.
The radiology of rheumatoid arthritis.
Am Fam Physician, 52 (1995), pp. 1372-1380
[5.]
A. Brook, M. Corbett.
Radiographic changes in early rheumatoid disease.
Ann Rheum Dis, 36 (1977), pp. 71-73
[6.]
D.L. Scott, B.L. Coulton, A.J. Popert.
Long term progression of joint damage in rheumatoid arthritis.
Ann Rheum Dis, 45 (1986), pp. 373-378
[7.]
M.J. Plant, P.W. Jones, J. Saklatvala, et al.
Patterns of radiological progression in early rheumatoid arthritis: results of an 8 year prospective study.
J Rheumatol, 25 (1998), pp. 417-426
[8.]
H.M. Hulsmans, J.W.G. Jacobs, D. Van der Heijde, et al.
The course of radiologic damage during the first six years of rheumatoid arthritis.
Arthritis Rheum, 43 (2000), pp. 1927-1940
[9.]
D. Van der Heijde, M. Boers, M. Lassere.
Methodological issues in radiographic scoring methods in rheumatoid arthritis.
J Rheumatol, 26 (1999), pp. 726-730
[10.]
J.J. Kaye.
Radiographic methods of assessment (scoring) of rheumatic disease.
Rheum Dis Clin North Am, 17 (1991), pp. 457-470
[11.]
S. Boini, F. Guillemin.
Radiographic scoring methods as outcome measures in rheumatoid arthritis: properties and advantages.
Ann Rheum Dis, 60 (2001), pp. 817-827
[12.]
A. Larsen, K. Dale, M. Eek.
Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films.
Acta Radiol Diagn Stockh, 18 (1977), pp. 481-491
[13.]
D.L. Scott, D.A. Houssien, L. Laasonen.
Proposed modification to Larsen's scoring methods for hand and wrist radiographs.
Br J Rheumatol, 34 (1995), pp. 56
[14.]
J. Edmonds, A. Saudan, M. Lassere, et al.
Introduction to reading radiographs by the Scott modification of the Larsen method.
J Rheumatol, 26 (1999), pp. 740-742
[15.]
J.T. Sharp, M.D. Lidsky, L.C. Collins, et al.
Methods of scoring the progression of radiologic changes in rheumatoid arthritis: correlation of radiologic, clinical and laboratory abnormalities.
Arthritis Rheum, 14 (1971), pp. 706-720
[16.]
J.T. Sharp, D.Y. Young, G.B. Bluhm, et al.
How many joints in the hands and wrists should be included in a score of radiologic abnormalities used to assess rheumatoid arthritis?.
Arthritis Rheum, 28 (1985), pp. 1326-1335
[17.]
D. Van der Heijde, P.L. Van Riel, I.H. Nuver-Zwart, et al.
Effects of hydroxychloroquine and sulphasalazine on progression of joint damage in rheumatoid arthritis.
Lancet, (1989), pp. 1036-1038
[18.]
D. Van der Heijde.
How to read radiographs according to the Sharp/Van der Heijde method.
J Rheumatol, 27 (2000), pp. 261-263
[19.]
D. Van der Heijde.
Quantification of radiological damage in inflammatory arthritis: rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis.
Best practice & Research Clinical Rheumatology, 18 (2004), pp. 847-860
[20.]
S. Wassenberg, G. Herborn, A. Larsen, et al.
Reliability, precision and time expense of four different radiographic scoring methods.
Arthritis and Rheumatism, 41 (1998), pp. S50
[21.]
K. Bruynesteyn, D. Van der Heijde, M. Boers, S. Van der Linden, M. Lassere, C. Van der Vleuten.
The Sharp/Van der Heijde method out-perfomed the Larsen/Scott method on the individual patient level in assessing radiographs in erarly rheumatoid arthritis.
Journal of Clinical Epidemiology, 57 (2004), pp. 502-512
[22.]
S. Wassenberg, R. Rau.
Problems in evaluating radiographic findings in rheumatoid arthritis using different methods of radiographic scoring: examples of difficult cases and a study design to develop an improved scoring method.
J Rheumatol, 22 (1995), pp. 1990-1997
[23.]
V. Strand, J.T. Sharp.
Radiographic data from recent randomized controlled trials in rheumatoid arthritis.
Arthritis Rheum, 48 (2003), pp. 21-34
[24.]
Boonen A. Van der Heijde, M. Boers, et al.
Reading radiographs in cronological order, in pairs or as single films has important implications for the discriminative ower of rheumatoid arthritis clinical trials.
Rheumatology, 38 (1999), pp. 1213-1220
[25.]
R. Ferrara, F. Priolo, M. Cammisa, et al.
Clinical trials in rheumatoid arthritis: methodological suggestions for assessing radigraphs arising from the Grisar study.
Ann Rheum Dis, 56 (1997), pp. 608-612
[26.]
D. Van der Heijde, L. Simon, J. Smolen, et al.
How to report radiographic data in randomized clinical trials in rheumatoid arthritis? Guidelines from a roundtable discussion.
Arthritis Rheum, 47 (2002), pp. 215-218
[27.]
D. Van der Heijde, M. Boers.
Prevention or retardation of joint damage in rheumatoid arthritis.
Drugs, 62 (2002), pp. 1717-1724
[28.]
M. Lassere, M. Boers, D. Van der Heijde, et al.
Smallest detectable difference in radiological progression.
J Rheumatol, 26 (1999), pp. 731-739
[29.]
R. Landewé, D. Van der Heijde.
Radiographic progression depicted by probability plots.
Arthritis Rheum, 50 (2004), pp. 699-706
[30.]
D. Van der Heijde, R. Landewe, L. Klareskog, V. Rodriguez-Valverde, L. Settas, R. Pedersen, et al.
Presentation and analysis of data on radiographic outcome in clinical trial.
Arthritis Rheum, 52 (2005), pp. 49-60
[31.]
D. Van der Heijde, M. Van Leeuwen, P. Van Riel.
Biannual radiographic assessments of hands and feet in three-year prospective follow-up of patients with early rheumatoid arthritis.
Arthritis Rheum, 35 (1992), pp. 26-34
[32.]
E. Lindqvist, K. Jonsson, T. Saxne, et al.
Course of radiographic damage over 10 years in a cohort with early rheumatoid arthritis.
Ann Rheum Dis, 62 (2003), pp. 611-616
[33.]
F. Wolfe, J.T. Sharp.
Radiographic outcome of recent- onset rheumatoid arthritis: a 19-year study of radiographic progression.
Arthritis Rheum, 41 (1998), pp. 1571-1582
[34.]
T. Pincus, G. Ferraccioli, T. Sokka, A. Larsen, R. Rau, I. Kushner, et al.
Evidence from clinical trials and long-term observational studies that disease-modifying anti-rheumatic drugs slow radiographic progression in rheumatoid arthritis: updating a 1983 review.
Rheumatology, 41 (2002), pp. 1346-1356
[35.]
J.R. Kirwan.
The effect of glucocorticoids on joint destruction in rheumatoid arthritis. The arthritis and rheumatism council low-dose glucocorticoid study group.
N Eng Med, 333 (1995), pp. 142-146
[36.]
R. Rau, S. Wassenberg, H. Zeidler, LDPT-Study Group.
Low dose prednisolone therapy (LDPT) retards radiographically detect destruction in early rheumatoid arthritis-preliminary results of a multicenter, randomized, parallel, double blind study.
Z Rheumatol, 59 (2000),
[37.]
A.A. Van Everdingen, J.W. Jacobs, D.R. Siewertsz van Reesema, J.W. Bijslma.
Low-dose prednisone therapy for patients with early rheumatoid arthritis: clinical efficacy, disease-modifying propierties, and side effects: randomized, double bind, placebo-controlled clinical trial.
Ann Intern Med, 136 (2002), pp. 1-12
[38.]
A.A. Stenger, M.A. Van Leeuwen, P.M. Houtman, et al.
Early effective supression of inflammation in rheumatoid arthritis reduces radiographic progression.
Br J Rheumatol, 37 (1998), pp. 1157-1163
[39.]
M. Boers, A.C. Verhoeven, H.M. Markusse, et al.
Randomised comparison of combined step-down prednisolone, methotrexate and sulphasalazine white sulphasalazine alone in early rheumatoid arthritis.
Lancet, 350 (1997), pp. 309-318
[40.]
T. Mottonen, P. Hannonen, M. Leirisalo-Repo, et al.
Comparison of combination therapy with single-drug therapy in early rheumatoid arthritis. A randomised trial. FIN-RACo trial group.
Lancet, 353 (1999), pp. 1568-1573
[41.]
D. Van der Heijde, P. Van Riel, I. Nuver-Zwart, F. Gribnau, L. Van de Putte.
Sulphasalazine versus hydroxychloroquine in rheumatoid arthritis: 3-year follow-up.
Lancet, 335 (1990), pp. 539
[42.]
G.J. Carroll, R.K. Will, P.D. Breidahl, L.M. Tinsley.
Sulphasalazine versus penicillamine in the treatment of rheumatoid arthritis.
Rheumatol Int, 8 (1989), pp. 251-255
[43.]
O. Forre.
Radiologic evidence of disease modification in rheumatoid arthritis patients treated with cyclosporine. Results of a 48-week multicenter study comparing low-dose cyclosporin with placebo. Norwegian Arthritis Study Group.
Arthritis Rheum, 37 (1994), pp. 1506-1512
[44.]
G. Pasero, F. Priolo, E. Marubini, et al.
Slow progression of joint damage in early rheumatoid arthritis treated with cyclosporin A.
Arthritis Rheum, 39 (1996), pp. 1006-1015
[45.]
A.A. Drosos, P.V. Voulgari, I.A. Papadopoulos, E.N. Politi, P.E. Georgiou, A.K. Zikou.
Cyclosporine A in the treatment of early rheumatoid arthritis. A prospective, randomized 24-month study.
Clin Exp Rheumatol, 16 (1998), pp. 695-701
[46.]
J.W. Sigler, G.B. Bluhm, H. Duncan, J.T. Sharp, D.C. Ensign, W.R. Mc Crum.
Gold salts in the treatment of rheumatoid arthritis. A double-blind study.
Ann Intern Med, 80 (1974), pp. 21-26
[47.]
P.l. Van Riel, A. Larsen, L.B. Van de Putte, F.W. Gribnau.
Effects of aurothioglucose and auranofin on radiographic progression in rheumatoid arthritis.
Clin Rheumatol, 5 (1986), pp. 359-364
[48.]
R. Rau, M. Schattenkirchner, H. Muller-Fassbender, B. Kaik, B. Zeidler Missler.
A three year comparative study of auranofin and gold sodium thiomalate in rheumatoid arthritis.
Clin Rheumatol, (1990), pp. 461-474
[49.]
R. Rau, G. Herborn, T. Karger, H. Menninger, D. Elhardt, J. Schmitt.
A double-blind comparison of parenteral methotrexate and parenteral gold in the treatment of early erosive rheumatoid arthritis: an interim report of 102 patients after 12 months.
Semin Arthritis Rheum, 21 (1991), pp. 13-20
[50.]
M.E. Jeurissen, A.M. Boerbooms, L.B. Van de Putte, W.H. Doesburg, A.M. Lemmens.
Influence of methotrexate and azatioprine on radiologic progression in rheumatoid arthritis. A randomized, double-blind study.
Ann Intern Med, 114 (1991), pp. 999-1004
[51.]
M.E. Weinblatt, R. Polisson, S.D. Blotner, J.L. Sosman, P. Aliabadi, N. Bake, et al.
The effects of drug therapy on radiographic progression of rheumatoid arthritis. Results of a 36-week randomized trial comparing methotrexate and auranofin.
Arthritis Rheum, 36 (1993), pp. 613-619
[52.]
A.A. Drosos, N. Tsifetaki, E.K. Tsiakou, M. Timpanidou, C. Tsampoulas, C.K. Tatsis, et al.
Influence of mehotrexate on radiographic progression in rheumatoid arthritis: a sixty-month prospective study.
Clin Exp Rheumatol, 15 (1997), pp. 263-267
[53.]
J.T. Sharp, V. Strand, H. Leung, et al.
Treatment with leflunomide slows radiographic progression of rheumatoid arthritis: results from three randomized controlled trials of leflunomide in patients with active rheumatoid arthritis.
Arthritis Rheum, 43 (2000), pp. 495-505
[54.]
V. Strand, S. Cohen, M. Schiff, et al.
Treatment of active rheumatoid arthritis with leflunomide compared with placebo and methotrexate.
Arch Intern Med, 159 (1999), pp. 2542-2550
[55.]
J.S. Smolen, J.R. Kalden, D.L. Scott, B. Rozman, T.K. Kvien, A. Larsen, et al.
Efficacy and safety of leflunomide compared with placebo and sulphasalazine in active rheumatoid arthritis: a double-blind, randomised multicentre trial. European Leflunomide Study group.
Lancet, 353 (1999), pp. 259-266
[56.]
P. Emery, F.C. Breedveld, E.M. Lemmel, et al.
A comparison of the efficacy and safety of leflunomide and methotrexate for the treatment of rheumatoid arthritis.
Rheumatology, 39 (2000), pp. 655-665
[57.]
B. Bresnihan, J.M. Alvaro-Gracia, M. Cobby, et al.
Treatment of active rheumatoid arthritis with recombinant human interleukin-1 receptor antagonist.
Arthritis Rheum, 41 (1998), pp. 2196-2204
[58.]
I. Watt, M. Cobby.
Treatment of rheumatoid arthritis patients with interleukin-1 receptor antagonist: radiologic assessment.
Semin Arthritis Rheum, 30 (2001), pp. 21-25
[59.]
H.K. Genant.
Interleukin-1 receptor antagonist treatment of rheumatoid arthritis patients: radiologic progression and correlation of Genant/Sharp and Larsen scoring methods.
Semin Arthritis Rheum, 30 (2001), pp. 26-32
[60.]
J.M. Bathon, R.W. Martin, R.M. Fleischmann, et al.
A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis.
N Engl J Med, 343 (2000), pp. 1586-1593
[61.]
M.C. Genovese, J.M. Bathon, R.W. Martin, et al.
Etanercept versus methotrexate in patients with early rheumatoid arthritis: two year radiographic and clinical outcomes.
Arthritis Rheum, 46 (2002), pp. 1443-1450
[62.]
L. Klareskog, D. Van der Heijde, J.P. De Jager, et al.
Therapeutic effect of the combination of etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: double-blind randomised controlled trial.
Lancet, 363 (2004), pp. 675-681
[63.]
P.E. Lipsky, D. Van der Heijde, E.W. St Clair, et al.
Infliximab and methotrexate in the treatment of rheumatoid arthritis.
N Engl J Med, 343 (2000), pp. 1594-1602
[64.]
R.N. Maini, F.C. Breedveld, J.R. Kalden, J.S. Smolen, D. Furst, M.H. Weisman, et al.
Sustained improvement over two years in physical function, structural damage, and signs and symptoms among patients with rheumatoid arthritis treated with infliximab and methotrexate.
Arthritis Rheum, 50 (2004), pp. 1051-1065
[65.]
E.C. Keystone, A.F. Kavanaugh, J.T. Sharp, et al.
Radiographic, clinical, and functional outcomes of treatment with adalimumab (a human anti-tumor necrosis factor monoclonal antibody) in patients with active rheumatoid arthritis receiving concomitant methotrexate therapy.
Arthritis Rheum, 50 (2004), pp. 1400-1411
[66.]
V. Strand, R. Landewé, D. Van der Heijde.
Using estimated yearly progression rates to compare radiographic data across recent randomised controlled trials in rheumatoid arthritis.
Ann Rheum Dis, 61 (2002), pp. 64-66
[67.]
J.T. Sharp, D. Van der Heijde, M. Boers, et al.
Repair of erosions in rheumatoid arthritis does occur. Results from 2 studies by the OMERACT Subcommitte on Healing of Erosions.
J Rheumatol, 30 (2003), pp. 1102-1107
[68.]
D. Van der Heijde, J.T. Sharp, R. Rau, V. Strand.
OMERACT workshop: repair of structural damage in rheumatoid arthritis.
J Rheumatol, 30 (2003), pp. 1108-1109
[69.]
Rau R, Herborn G, Wassenberg S. Healing of erosive changes in rheumatoid arthritis. Clin Exp Rheumatol. 200;22 Suppl35:S44-9.
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