How do you approach management of patients with inflammatory arthritis who are asymptomatic but develop radiographic progression?

Radiographic disease progression remains the gold standard test for assessing disease activity in patients with RA. Therefore, any time one notes progression of radiographic change, this finding needs to be taken seriously. Since plain radiographs may take many months or years to demonstrate such changes, the damage may reflect remote joint and cartilage disease and may not correlate with the current physical exam and lab findings in any given patient. A careful assessment of the timeline of the current drug regimen should be undertaken to determine whether the damage implicates a drug that is currently being prescribed.

In summary, radiographic progression identifies patients with suboptimal disease control that should prompt the treating ...