• rheumatoid arthritis
• randomised controlled trials
• radiographic damage

• CRP, C reactive protein
• IL1Ra, interleukin 1 receptor antagonist
• RCTs, randomised controlled trials

This review is based on publications and presented abstracts from six randomised controlled trials (RCTs) in the treatment of rheumatoid arthritis assessing treatment effects on radiographic measures of disease progression. Each used the Sharp scoring method to assess changes in erosions and joint space narrowing from baseline.^1–3 These RCTs showed that the newly approved synthetic and biological disease modifying antirheumatic drugs, leflunomide, infliximab, etanercept, and Anakinra, were effective, and confirmed the efficacy of sulfasalazine and methotrexate in retarding disease progression.^4–13 Provided that sample sizes are adequate, randomisation within a protocol accounts for the heterogeneity of disease populations and yields linear progression rates over time.¹⁴

Each RCT enrolled a unique patient group with significantly different demographics and baseline disease characteristics across the trials, although well balanced within each protocol. Because of these population differences it is not appropriate to compare directly changes in total composite (Sharp) scores across trials. However, it is possible to compare the data if one uses an estimate of yearly progression of radiographic damage, based on prior progression, where patients have continued to receive previous treatment, …