Keywords
Larsen score
radiographic damage
anti-CCP
disease duration
structural joint damage
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Abstract
Background: Radiographic joint damage is a primary determinant of long-term disability in rheumatoid arthritis (RA). This study aimed to identify the clinical and serological factors associated with structural damage, as quantified by the Larsen score, in a cohort of Egyptian patients with RA. Methods: This cross-sectional study enrolled 162 Egyptian patients with RA who fulfilled the 2010 ACR/EULAR classification criteria. Clinical manifestations, disease activity (DAS28-ESR), functional disability (HAQ), and serological profiles (RF and anti-CCP) were systematically recorded. Radiographic damage in the hands and feet was evaluated using the Larsen scoring method by two independent assessors. Multivariable linear regression, utilizing log-transformed Larsen scores, was conducted to determine factors independently associated with structural damage. Results: The cohort was predominantly female (91.4%), with a mean age of 38.1±9.2 years and a mean disease duration of 3.74±3.4 years. The median Larsen score was 5 (interquartile range [IQR], 2–14), demonstrating excellent inter-reader agreement (ICC=0.92). Univariate analysis revealed that patients with subcutaneous nodules and anti-CCP positivity exhibited significantly higher Larsen scores (p<0.01). Upon multivariable analysis, prolonged disease duration (β=0.46, p<0.001), the presence of subcutaneous nodules (β=0.22, p=0.002), and anti-CCP positivity (β=0.14, p=0.035) emerged as independent correlates of advanced radiographic damage, collectively explaining 34.2% of the variance (adjusted R²=0.342, p<0.001). Conclusions: Prolonged disease duration, subcutaneous nodules, and anti-CCP positivity are independently associated with exacerbated radiographic joint damage in Egyptian patients with RA. Utilizing these accessible clinical markers can effectively stratify patients at elevated structural risk, thereby underscoring the critical need for prompt and sustained disease control.
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