Study Indicated Erosion-Free Patients With Rheumatoid Arthritis Had Less Severe Disease Course

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A total of 608 patients from an early RA cohort that had baseline radiographs of hands and feet, as well as at 1, 2, 5, and 8 years, were included in the long-term study.

Patients with early rheumatoid arthritis (RA) who were erosion-free during an 8-year study period had a less severe disease course as to disease activity. These patients were also more often seronegative when compared with those with erosive disease, according to a study published in BMC Rheumatology.1

“In most patients, bone erosions resulting in joint destruction appear during the course of disease,” investigators stated. “Early therapy has been shown to be effective in achieving control of disease activity and retarding radiographic damage. A proportion of patients never develops erosions and identifying these patients at an early stage may be of relevance for the choice of treatment.”

A total of 608 patients from an early RA cohort, Better Anti-Rheumatic FarmacOTherapy (BARFOT), that had baseline radiographs of hands and feet, as well as at 1, 2, 5, and 8 years, were included in the long-term study. The study, which analyzed the prevalence, relevance, and potential predictors of erosion-free RA, conducted clinical and functional assessments at these timepoints. Disease activity was evaluated via the Disease Activity Score, calculated on 28 joints (DAS28) and daily life function was measured by the Swedish version of the Health Assessment Questionnaire (HAQ). Radiographs of the hands and feet were assessed using the van der Heijde modification of the Sharp score (SHS).

During the 8-year follow-up period, 144 patients (24%) did not develop erosions (Never erosive group); however, 464 patients (76%) had erosions on 1 or more assessments. These patients were placed in the “Ever erosive group.”

Patients in the Never erosive group satisfied fewer American College of Rheumatology (ACR) 1987 revised criteria for the classification of RA, were less frequently rheumatoid factor (RF)- and/or antibodies to cyclic citrullinated peptides (anti-CPP)-positive (44 patients vs 31, respectively; p = 0.01), and were significantly younger (52 vs 56 years, respectively; p = 0.001) when compared with the Ever erosive group. Further, the Never erosive cohort had a lower erythrocyte sedimentation rate (ESR), more tender joints, and from the 2-year mark onwards, reported fewer swollen joints.

Erosion-free disease was strongly predicted by the absence of RF and/or anti-CPP. Additionally, patients deemed erosion-free were less frequently treated with prednisone and/or disease-modifying antirheumatic drugs (DMARDs).

The long observational period, which helped to study the course of RA radiographically from onset, strengthened the study. The large sample size, as well as radiographic data, also strengthened the study. However, a limitation was that all patients were included between 1992 and 2006, a time at which medications and treatment strategies changed. Lastly, anti-CPP was only available in 70% of patients in the 2000s.

“This study confirms previous observations suggesting that an initially erosion-free RA may remain non-erosive during a long disease course or may become erosive in a later stage,” investigators concluded. “We believe that the demonstrated demographic and clinical differences between Never erosive and Ever erosive patients are not distinct enough to suggest different disease entities but might be explained by different pathophysiological mechanisms for erosions.”


Svensson B, Andersson MLE, Gjertsson I, Hafström I, Ajeganova S, Forslind K. Erosion-free rheumatoid arthritis: clinical and conceptional implications-a BARFOT study. BMC Rheumatol. 2022;6(1):88. Published 2022 Dec 30. doi:10.1186/s41927-022-00317-4