Prediction of radiological outcome in early rheumatoid arthritis in clinical practice: role of antibodies to citrullinated peptides (anti-CCP)

OBJECTIVE: To investigate the role of anti-cyclic citrullinated peptide antibody (anti-CCP) for the prediction of radiological outcome in patients with early rheumatoid arthritis. METHODS: Anti-CCP was assessed at baseline in 379 patients with early rheumatoid arthritis (disease duration <1 year). Radiological joint damage and progression were assessed by Larsen score after two years of follow up (end point) and used as outcome variables. The prognostic value of anti-CCP and other demographic and disease related baseline variables were assessed by univariate and multivariate analyses, including calculation of odds ratios (OR), predictive values, and multiple logistic regression models. RESULTS: The presence of anti-CCP was associated with significantly higher Larsen score both at baseline and at end point. Univariate predictor analysis showed that anti-CCP had the highest significant OR for radiological joint damage and progression after baseline Larsen score, followed by rheumatoid factor, erythrocyte sedimentation rate (ESR), C reactive protein, age, smoking status, and sex. In stepwise multiple regression analyses, baseline Larsen score, anti-CCP, and ESR were selected as significant independent predictors of the radiological outcomes. CONCLUSIONS: There is good evidence for an association of anti-CCP with radiological joint changes in rheumatoid arthritis. Anti-CCP is an independent predictor of radiological damage and progression. Though prediction in early rheumatoid arthritis is still far from perfect, the use of anti-CCP in clinical practice should make it easier for rheumatologists to reach judicious treatment decisions.     

Predicting outcome at the knee in juvenile rheumatoid arthritis

This study was undertaken to correlate long-term severe radiographic changes with clinical profiles in an attempt to identify a group of patients at risk. Knee radiographs of 100 juvenile rheumatoid arthritis (JRA) patients with 1-20 years of follow-up studies were reviewed for changes leading to severe disability. Eighteen children had evidence of destructive changes an average of 4.3 years after onset of JRA. 23 patients had reactive changes superimposed on destructive changes seen 9.7 years after onset of disease. 92% of the children with reactive and destructive knee changes had radiographic evidence of significant JRA at another joint. Polyarticular disease with significant JRA involvement of another joint seems to indicate a group of children at higher risk for destructive and reactive changes at the knee.     

Destructive arthritis in Behçet’s disease: a report of eight cases and literature review

Behçet’s disease (BD) is a multisystemic disease with typically non‐erosive and non‐deforming joint manifestations. The occurrence of destructive arthritis in Behçet’s disease has rarely been reported. Here we attempt to define the epidemiological, clinical and radiological features of this unusual type of osteoarticular manifestation of BD. We retrospectively reviewed the medical records of 553 patients with Behçet’s disease seen over 25‐year period in our department of Internal Medicine (Sfax‐Tunisia). All the patients fulfilled The International Study Group of Behçet’s Disease criteria. Patients with destructive arthritis (defined by radiological changes: erosions and/or geodes and/or global narrowing of the joint space and/or ankylosis) were included in this study. Rheumatologic manifestations were observed in 71.1% patients. Eight patients (1.4% overall, 2% among patients with rheumatologic manifestations) had presented with destructive arthritis. The joint symptoms involved the knee in two cases, the wrist in one case, the elbow (one case), the sternoclavicular joint in two cases, the foot in one case and the tarsal scaphoïd in one case. There was recurrent arthritis at the same joint in the majority of cases. X‐ray examinations revealed radiological changes: global narrowing of the joint in one case (knee), narrowing of the joint with geodes in three cases (knee, sternoclavicular), isolated geodes in two cases (tarsal scaphoid, foot) and severe lesions with ankylosis in two cases (two elbows, right wrist). Joint manifestations are common in patients with BD, but destructive arthritis is rare.     

Early rheumatoid arthritis: does gender influence disease expression?

OBJECTIVE: To investigate whether gender is an independent factor associated with disease expression in early rheumatoid arthritis (RA) patients. METHODS: 438 patients with early RA (disease duration less than one year) were studied. They all were patients with early RA who presented at the Rheumatology Clinic of the University Hospital of Ioannina during the period 1991-2000. All patients fulfilled the American College of Rheumatology criteria for RA. The demographic, clinical, laboratory, radiological and therapeutic characteristics of the disease at diagnosis, and at the last follow-up were analyzed according to gender. RESULTS: We studied 312 women and 126 men with early RA. The female to male ratio was 2.5:1 and the mean age at diagnosis was 49.4 +/- 14.9 years for women and 55.3 +/-15.6 years for men (P < 0.0003). Women had a longer duration of follow-up (P < 0.0003). There were no differences between genders in the general symptoms or the simmetricity of joint involvement at at disease onset. However at disease onset women had a higher erythrocyte sedimentation rate (ESR) (> 30 mm/1st hour), although there were no significant differences between the two groups concerninig the rest of the clinical, laboratory and radiological findings. At the last follow-up women still had a higher ESR (>30 min/1st hour), but no significant differences were found between the two groups concerning the rest of the parameters investigated independently of the follow-up duration. Finally, women and men showed the same degree of radiological changes and functional ability and were treated similarly except for the more frequent use of hydroxychloroquine in women. CONCLUSION: It seems that gender does not signficantly influence the expression of RA.     

The arthropathy of systemic sclerosis (scleroderma); comparison with mixed connective tissue disease

Arthritis in systemic sclerosis (PSS) can be prominent and an overlap with rheumatoid arthritis (RA) has sometimes been queried. We therefore analysed the pattern of joint involvement of hands and wrists in 34 patients (1 male) with PSS and compared it with that of 9 patients with mixed connective tissue disease (MCTD), a condition with distinct overlap features. Although MCTD patients were younger, disease duration was similar in both groups. Extra-articular radiological findings such as calcinosis, pulp atrophy and tuft resorption were present in over half the patients with PSS but were less frequent in MCTD. Marginal erosions occurred in over 50% and ulnar styloid erosions in 35% of the PSS patients. Erosions of the 1st CMC joint were seen in one-third of them and were unrelated to age. Erosions did not correlate with clinical synovitis, the presence of rheumatoid factor which was present in 26% of PSS patients or the presence of anti-centromere or anti-Scl-70 antibodies. Erosions in MCTD patients occurred frequently and were more destructive and rapidly progressive. Correlation between erosions, rheumatoid factor and clinical arthritis was high. We conclude that erosions in PSS are frequent. Their pattern is varied but usually discrete and seldom destructive. They are not related to arthritis or serological abnormalities and may be due to several mechanisms aside from synovitis. In contrast, erosions in MCTD are more frequently destructive and related to arthritis and rheumatoid factor, suggesting a true overlap.     

Older age onset rheumatoid arthritis with or without osteoarthritis.

The clinical features of a group of 79 patients with older age onset rheumatoid arthritis (ORA) were compared with those of a group of 414 patients with younger age onset rheumatoid arthritis. The ORA group contained approximately equal numbers of men and women, were less rheumatoid factor positive, had a raised erythrocyte sedimentation rate, lower HLA-DR4 positivity, and a tendency towards larger joint involvement at the onset of the disease. These features have been reported by many authors except for the lower DR4 positivity. Of these features, the lower prevalence of rheumatoid factor positivity and the tendency towards larger joint involvement at the onset were characteristic of a subset of patients with ORA who had had osteoarthritis before the onset of rheumatoid arthritis. It is suggested that osteoarthritic large joints may be susceptible to the occurrence of rheumatoid synovitis at the onset of the disease, but that the osteoarthritis inducing factor may be negatively related to the progression of rheumatoid arthritis.     

The value of synovial fluid analysis in the assessment of knee joint destruction in arthritis in a three year follow up study

OBJECTIVES: To assess the predictive significance of synovial fluid (SF) analysis for progressive radiological knee joint destruction in arthritis. METHODS: Altogether 55 patients with arthritis and knee joint effusion were included in the study. The diagnosis was rheumatoid arthritis (RA) for 44 of them, chronic seronegative spondylarthropathy for seven and juvenile rheumatoid arthritis for four. The mean age of the patients was 51.8 (SD 14.9, range 19-82) years, and the mean duration of disease 10.9 (SD 9.2, range 0.5-37) years. In addition to the routine laboratory tests, different markers of collagen synthesis and breakdown in serum and SF were assessed. The radiological grade of the knee joint was assessed by Larsen's method at the baseline and after a three year follow up. RESULTS: During the follow up, Larsen's grade deteriorated in 22 (40%) patients. These patients had a significantly higher median level of cross linked carboxyterminal telopeptide of type I collagen (ICTP) in SF at entry than those who had a stable index (p = 0.035). Serum ICTP did not have any predictive value for a specific joint. The median levels of total SF leucocytes (p = 0.012) and the subgroup of polymorphonuclear leucocytes (p = 0.018) were higher in the patients with a stable Larsen's index. However, the relation of SF leucocyte level to radiological progression could not be confirmed in the RA group. CONCLUSION: It is concluded that SF analysis may help in the identification of patients with inflammatory arthritis who are at risk for progressive destruction in a particular joint. A high total SF leucocyte level is not necessarily associated with a poor prognosis. Instead, a high SF ICTP level seems to reflect accelerated bone degradation.     

Progression of radiological changes in rheumatoid arthritis.

A prospective study over one year of patients who had active rheumatoid arthritis discovered 64 who had received treatment for an adequate time with second-line drugs. In these patients there was evidence of continuing joint destruction as shown by radiological progression. During the year there were highly significant correlations between improvements in clinical and laboratory measurements, but neither group of tests was related to the degree of radiological change. However, in the second 6 months of treatment there was evidence that radiological progression was reduced. In a second prospective study of 88 patients with rheumatoid arthritis given prolonged, intensive therapy with second-line drugs and followed up for 10 years two-thirds showed radiological progression. However, the number of joints damaged per year fell significantly during the study period. There was a divergence between deterioration in radiological features and improvements in the ESR and functional capacity, though patients with a persistently low ESR had less radiological progression. These studies provide evidence that treatment may be associated with a reduced rate of radiological progression but suggest that changes in radiological progression and clinical and laboratory measurements may result from different mechanisms.     

Anti-cyclic citrullinated peptide (anti-CCP) antibodies in children with juvenile idiopathic arthritis

OBJECTIVE: To determine if anti-cyclic citrullinated peptide antibodies (anti-CCP) can be detected in sera of patients with juvenile idiopathic arthritis (JIA) and if they can be used to identify patients with a more destructive course of disease. METHODS: One hundred serum samples of 71 patients with JIA taken at different time points in their disease course were analyzed by a commercially available anti-CCP ELISA. Followup serum samples from 28 patients were also tested. Correlations between anti-CCP and disease characteristics, medication, and radiological damage (presence of joint space narrowing and/or erosions) were also determined. RESULTS: The serum samples came from patients of all 8 different subtypes of JIA (mean age: 9.6 years, median: 10.5; disease duration mean: 39 months, median: 24) including 11 polyarticular rheumatoid factor positive (IgM-RF) patients. Anti-CCP was positive in 73% of the IgM-RF positive JIA patients and in 3% of the other JIA patients (p < 0.0001). Disease duration, medication, and anti-nuclear antibody positivity did not differ significantly between anti-CCP positive and negative patients. Testing of followup samples showed almost identical anti-CCP results. All IgM-RF positive JIA patients had radiological damage (p < 0.001). Of the anti-CCP positive patients, 80% had radiological damage resulting in a significant difference between anti-CCP positive and negative patients (p = 0.009) with an odds ratio (OR) of 12.7, but corrected for IgM-RF, the OR was no longer significant (p = 0.88). CONCLUSION: Anti-CCP antibodies can be detected in the sera of patients with JIA but almost exclusively in the subset of patients with polyarticular IgM-RF.     

The association of race and ethnicity with disease expression in male US veterans with rheumatoid arthritis

OBJECTIVE: To examine the association of race/ethnicity with measures of disease activity and severity among male US veterans with rheumatoid arthritis (RA). METHODS: Measures of disease activity and severity were examined in a group of US veterans (n = 573) with RA, comparing measures in African American men (n = 79) with Caucasian men (n = 494). Dichotomous variables were compared using logistic regression while continuous variables were examined using linear regression, adjusting for the effects of age, disease duration, and smoking status. RESULTS: Compared to Caucasians, African Americans were slightly younger (65.0 vs 67.1 yrs; p = 0.09) at enrollment and had a similar age at disease onset (50.5 vs 50.6 years; p = 0.98). After adjusting for age, disease duration, and smoking status, there were no differences based on race/ethnicity in rheumatoid factor positivity, the presence of radiographic changes, physical functioning, swollen joint counts, Disease Activity Score (DAS28), or global well-being scores. In contrast, African Americans were about 50% less likely than Caucasians with RA to have subcutaneous nodules (adjusted OR 0.51, 95% CI 0.30-0.86) and had lower tender joint counts (p = 0.007), associations that were attenuated and not significant with further adjustment for collection site. CONCLUSION: With the possible exception of lower rates of rheumatoid nodules and lower tender joint counts in African Americans, there is little evidence to support the existence of important racial/ethnic differences in RA disease expression between African American and Caucasian men.     

The prediction of radiological destruction during the early stage of rheumatoid arthritis

A total of 107 patients with definite rheumatoid arthritis of no longer than six months' duration were observed for three years. The radiological destruction of the hand and foot joints after the follow-up time was compared with 65 anamnestic, clinical, laboratory and radiological variables at the onset of the disease. Of the individual variables, early radiological changes in the joints showed the best correlation with the progress of joint destruction. Grip strength, ESR, serum iron, serum C1 esterase inhibitor, rheumatoid factor and old age also had prognostic value. In multiple regression analysis 15 variables explained about 50% of the variance in the progress of joint destruction.     

Temporomandibular disorders in rheumatoid arthritis.

OBJECTIVE: To determine the frequency and character of temporomandibular disorders (TMD) in Oriental patients with rheumatoid arthritis (RA) and to investigate the relationship between TMD and RA in a tertiary referral center. METHODS: Symptoms and signs related to TMD were investigated in 80 patients (67 female, 13 male) who fulfilled the American College of Rheumatology 1987 revised criteria for RA. Diagnoses of TMD including muscle, disk displacement, or temporomandibular joint (TMJ) disorders were made based on clinical assessment. TMJ disorder was then correlated with the clinical, laboratory, and radiological features of RA. RESULTS: The mean age of the study population was 49.7 years and the mean duration of RA was 86.9 months. Eleven patients (13.8%) had active RA at the time of TMD assessment. About 76% of the study population had seropositive disease and 62% had peripheral joint erosions. Osteoarthrosis of the TMJ was the most common TMD in this Oriental population. Joint sounds on opening (35%), joint sounds on moving sideways or forward (27.5%), and pain in jaw joints (23.7%) were common TMD symptoms. Deviated mouth opening (45%) and coarse crepitus (15-21.3%) were most prevalent on examination. CONCLUSION: Patients with RA who had prolonged disease duration of RA and active peripheral joints tended to have osteoarthrosis of the TMJ. Presence of rheumatoid factor or peripheral joint erosions was not associated with TMJ osteoarthrosis.     

A population based assessment of the use of orthopedic surgery in patients with rheumatoid arthritis

OBJECTIVE: To describe the use of orthopedic surgery, including joint replacement surgery, in a well defined population based cohort of patients with rheumatoid arthritis (RA) and to identify characteristics that predict such use. METHODS: A retrospective medical record review was performed of cases of RA incident in Rochester, MN, during the years 1955-85. Patients were followed until 1998. All joint surgeries were recorded, including joint reconstructive surgeries, total joint arthroplasty (TJA), and other joint reconstructive procedures (JRP) such as tendon transfers and resections, joint fusions, and surgeries for fractures and infections involving joints. RESULTS: Of the total 424 RA incident cases, 148 (34.9%) patients underwent one or more (maximum of 20/patient) surgical procedures involving joints during their followup (median 14.8 yrs, range 0.2-42.8 yrs). Overall, this RA cohort had 9.7 surgeries per 100 person-yrs of followup. The estimated cumulative incidence of surgical procedures for RA at 30 yrs was 52.7% +/- SE 4.2. Surgeries for arthritis related joint disease of RA included: primary TJA 76 patients (31.3 +/- 4.1); JRP joint fusion 78 patients (29.4 +/- 3.5); JRP soft tissue 92 patients (29.8 +/- 3.3); and cervical spine fusion one patient. Non-RA (trauma and other) joint surgeries included TJA 26 patients (13.5 +/- 3.4) and arthrotomy for septic arthritis 8 patients (2.4 +/- 0.9). Based on Cox proportional hazards regression, the risk of having a disease related joint surgery for RA is increased in patients who are younger (p < 0.001), have positive rheumatoid factor (p = 0.01), and those with rheumatoid nodules (p < 0.001). There was a borderline significant increase in the risk of first joint surgery in women (p = 0.09). Women also had significantly more joint surgeries (11.5/100 person-yrs) than men (4.9/100 person-yrs; p < 0.001). Survival of patients who had surgery for RA related joint disease was similar to those who did not. CONCLUSION: This is the first population based assessment of joint surgeries performed in patients with RA. Reconstructive surgeries were common, and women had significantly more surgeries than men. Survivorship among patients with RA undergoing surgeries was similar to that of the RA patient population at large.     

HLA-DR antigens and disease patterns of rheumatoid arthritis

HLA-DR antigens were determined in 111 patients with classic or definite rheumatoid arthritis. HLA-DR4 was significantly (P corr. less than 10(-6] increased in patients with rheumatoid arthritis (54%) compared with controls (23.2%). HLA-DR 5 was decreased in rheumatoid arthritis (12.6% vs 26.4% of controls); however, the corrected P value was not significant. There were no significant differences with regard to various clinical, radiological and serological parameters between HLA-DR 4 positive and negative patients. However, a milder course of rheumatoid arthritis was observed in DR 7 positive patients: Patients with this antigen were associated significantly with seronegativity and low titers of IgM-rheumatoid factor. Despite a similar disease duration patients with DR 7 had a significantly lower number of joints with inflammatory arthritis (synovitic swelling with limitation of movement) and developed less frequently severe radiological changes as joint ankylosis than DR 7 negative patients. In addition to the well known association between rheumatoid arthritis and HLA-DR 4, our data indicate that HLA-DR 7 may have a protective effect on the course of rheumatoid arthritis.     

Results of different long term treatments of patients in the early stages of rheumatoid arthritis]

In a clinical 5-year-study on 200 patients with rheumatoid arthritis with the help of the dynamics of radiological changes (radiological progressing), the joint deformation, the reduction of function and the new affection of joints (clinical progressing) as well as the medium position of activity the progressing of the disease and a good, satisfying or missing success of the long-term therapy were estimated. From the characteristics of the individual groups of therapy conclusions for the therapy in the early phase of the rheumatoid arthritis were derived.     

Atypical Arthropathy Associated with Crohn's Disease

Inflammatory bowel disease may be associated with a variety of rheumatologic abnormalities. The patterns of described enteropathic arthritis, not associated with the HLA B27 antigen, include non-deforming peripheral arthritis, bilateral, symmetric sacroiliitis, and on occasion, destructive monoarthritis. We report three patients with Crohn's disease and patterns of joint disease that have not been previously described. The patients ranged in age from 16 to 31 yr. In all cases, both joint and bowel disease were present since childhood. Antinuclear antibody, rheumatoid factor, and HLA B27 antigen determinations were negative. The distribution and pattern of joint disease were similar to that seen in rheumatoid arthritis. We propose that these cases do not represent coincident rheumatoid arthritis and Crohn's disease, but, rather, atypical manifestations of enteropathic arthritis.     

Lack of radiological and clinical benefit over two years of low dose prednisolone for rheumatoid arthritis: results of a randomised controlled trial

BACKGROUND: Evidence for disease modifying activity of low dose corticosteroid treatment in rheumatoid arthritis is contradictory. Studies showing radiological benefit suggest that continued treatment is required to sustain the effect. OBJECTIVE: To evaluate the effect of low dose oral prednisolone in early rheumatoid arthritis on disease activity over two years. DESIGN: Double blind placebo controlled trial. METHODS: Patients with rheumatoid arthritis, duration <3 years (n = 167), were started on a disease modifying antirheumatic drug (DMARD; sulphasalazine) and allocated by stratified randomisation to prednisolone 7 mg/day or placebo. Primary outcome measure was radiological damage, assessed by the modified Sharp method. Clinical benefit was a secondary outcome. A proactive approach to identifying and treating corticosteroid adverse events was adopted. Patients who discontinued sulphasalazine were offered an alternative DMARD. RESULTS: 90 of 257 patients eligible for the study refused to participate (more women than men). Of those enrolled, 84% were seropositive for rheumatoid factor, median age 56 years, median disease duration 12 months, female to male ratio 1.8:1. Prednisolone was given to 84 patients; of these 73% continued prednisolone and 70% sulphasalazine at 2 years. Of the 83 patients on placebo, 80% continued placebo and 64% sulphasalazine at 2 years. There were no significant differences in radiological score or clinical and laboratory measures at 0 and 2 years. CONCLUSIONS: Low dose prednisolone conferred no radiological or clinical benefit on patients maintained on a DMARD over two years. Low dose corticosteroids have no role in the routine management of rheumatoid arthritis treated with conventional disease modifying drugs.     

Rheumatoid pericarditis: clinical features and survival

We describe the clinical characteristics and actuarial survival of a consecutive cohort of 41 patients with rheumatoid arthritis and clinical pericarditis who were seen at the Mayo Clinic between 1970 and 1987 and followed up until death or through 1987. The survivors were followed up for a median of 5.1 years. Approximately three-fourths of our patients had acute pericarditis, the remainder having recurrent acute pericarditis, chronic pericarditis with effusion, or chronic constrictive pericarditis. Most patients had symmetrical joint swelling, morning stiffness, subcutaneous nodules, rheumatoid factor, and classic radiographic changes of rheumatoid arthritis. Common extra-articular features included fatigue, loss of weight, and fever. Dyspnea or orthopnea, typical pericardial pain, peripheral edema, tachycardia, tachypnea, a diminished mean blood pressure, a pericardial friction rub, jugular venous distension, rales, radiographic evidence of cardiomegaly and pleural effusions, and abnormal echocardiograms were the most common cardiac manifestations. An elevated erythrocyte sedimentation rate and anemia were other common laboratory findings. Our cohort demonstrated decreased survival in comparison with an age- and sex-matched North Central white population (from the upper midwestern United States), especially during the first year after diagnosis. Increasing age, the presence of other heart disease, an increasing total number of other extra-articular manifestations of rheumatoid arthritis, jugular venous distention, and a lower mean blood pressure were associated with decreased survival.     

HLA DR antigens and disease expression in rheumatoid arthritis.

Ninety-four patients with rheumatoid arthritis who possessed one or more of the HLA DR alloantigens 2, 3, or 4 were studied to investigate the genetic influence on disease severity and prognosis. In those with a disease duration of less than 10 years radiological damage was less in patients with DR2 than in those without this antigen. When current joint scores were compared, patients with this antigen had less evidence of disease than patients with DR3 or 4, DR3 patients having the highest scores. The presence of nodules and Sjögren's syndrome were less common in the DR2 patients. Variability in response to disease modifying drugs according to the patient's HLA DR antigen status may explain these differences. It is concluded, however, that possession of HLA DR2 may be an indicator of good prognosis in patients with rheumatoid arthritis.     

Magnetic resonance imaging findings of the cervical spine in patients with rheumatoid arthritis. A cross-sectional study

OBJECTIVES: To investigate by magnetic resonance (MR) imaging the occurrence of cervical spine (CS) involvement in rheumatoid arthritis (RA) patients. METHODS: Fifty-one consecutive unselected patients, who fulfilled the revised American College of Rheumatology criteria for RA, were investigated. All patients had a complete physical and laboratory evaluation. Radiological evaluation included hand and wrist x-rays, as well as CS radiographs in anteroposterior, lateral and lateral in full flexion views. In addition, MR (Spin Echo T2-weighted sagittal scans [neutral and flexion position], plain and contrast enhanced T1-weighted sagittal and axial scans) was performed in all patients. Hand x-rays were evaluated according to the Larsen's criteria, while CS radiographs were evaluated according to Winfield classification. Disease activity was assessed by disease activity score for 28 joint indices (DAS-28). RESULTS: There were 42 females and 9 males with a mean age of 56.5 +/- 10.4 years and mean disease duration 12.4 +/- 8.5 years. Thirty-three patients (64.7%) had positive IgM rheumatoid factor (RF). Thirty patients presented clinical findings, mainly cervical pain and stiffness of CS (25 with positive and 5 with negative MR), while, radiological findings of CS involvement were found in 40 patients. Forty-four patients (86.2%) presented MR findings of CS involvement (peridental pannus 88%; dens erosion 23.5%; atlantoaxial subluxation 13.7%; subaxial subluxations 10%; brainstem compression 5.9%). Peridental pannus correlated with high DAS-28, positive IgM RF and advanced erosive changes of the wrist and hand (p < 0.05) in the univariate analysis. However, multivariate logistic regression analysis did not confirm such correlation. CONCLUSIONS: We conclude that the frequency of CS involvement in Greek RA patients is high but the destructive changes are mild. However, in patients with active erosive peripheral disease it is very probable to also have some changes in CS. These may be clinically important and in such cases, MR may offer valuable information.