Erosion-free rheumatoid arthritis: clinical and conceptional implications-a BARFOT study

Björn Svensson, Maria L E Andersson, Inger Gjertsson, Ingiäld Hafström, Sofia Ajeganova, Kristina Forslind

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3 Citations (Scopus)
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BACKGROUND: Bone erosions may appear early or later during rheumatoid arthritis (RA), causing joint damage and functional impairment. However, in some patients erosions do not occur, even after several years of disease. This study evaluates the prevalence, clinical relevance and possible predictors of erosion-free RA.

METHODS: Six hundred and eight patients from an early RA cohort (BARFOT) having radiographs of hands and feet at inclusion and after 1, 2, 5 and 8 years were studied. Clinical and functional assessments were performed on all these time-points.

RESULTS: In all, 144 patients (24%) did not develop erosions up to 8 years follow-up (Never erosive group), while 464 patients (76%) had erosions on one or more assessments (Ever erosive group). At diagnosis, the patients in the Never erosive group were significantly younger, satisfied fewer ACR criteria, and were less frequently RF- and/or anti-CCP- positive compared with those in the Ever erosive group. The Never erosive patients had consistently more tender joints, lower erythrocyte sedimentation rate (ESR) and, from two years and onwards, fewer swollen joints. Absence of rheumatoid factor (RF) and/or anti-CCP were strong independent predictors for erosion-free disease. The erosion-free patients were less frequently treated with DMARDs and/or prednisolone.

CONCLUSIONS: One-quarter of the patients was erosion-free during eight years in this early RA cohort. Erosion-free patients had a less severe disease course as to disease activity and were more often seronegative compared with those with erosive disease. The results suggest that non-erosive RA represents a milder form of RA.

Original languageEnglish
Article number88
Number of pages9
JournalBMC rheumatology
Issue number1
Publication statusPublished - 30 Dec 2022

Bibliographical note

Funding Information:
Open access funding provided by Lund University. The study was funded by grants from the Swedish Rheumatism Association and the Foundation for Assistance to Disabled People in Skåne, Sweden.

Publisher Copyright:
© 2022, The Author(s).

Copyright 2023 Elsevier B.V., All rights reserved.


  • ACR criteria
  • Disease progress
  • Erosion-free
  • Erosions
  • Prognosis
  • Radiography
  • Rheumatoid arthritis


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