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aScores can range from 0 to 280, with higher scores indicating more joint damage.

It should be considered when an image guided approach is not possible or likely to cause more joint damage.

Likewise we postulated that inflammation at diagnosis is more severe at older age resulting in more joint damage.

Pain can also serve as a protective mechanism for a person to avoid activities that lead to more joint damage.

As expected, the cluster of patients with the highest percentage ACPA-positive patients displayed more joint damage than the ACPA-negative cluster.

Also in this group of patients, an increase in age was associated with more joint damage at baseline; also here the effect was constant over time.

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Similar(47)

Anti-Sa antibodies were the single serological marker independently predictive of poor outcomes and, together with the presence of joint erosions at inclusion and with increasing age, characterized a subgroup of patients with more rapid and more severe joint damage.

In our EPA cohort treated in accordance with current standards, detection of anti-Sa but not of RF or anti-CCP antibodies, in combination with clinical and radiological variables present at the first encounter, allowed the identification of a subgroup of EPA patients suffering more rapid and more severe joint damage over 30 months.

Furthermore, RA patients with anti-CCP antibodies were more likely to have more radiographic joint damage than patients without anti-CCP antibodies.

There is evidence, however, that RA patients with anemia have a more severe form of the disease and more serious joint damage [ 2- 4].

More importantly, mice lacking Nrf2 developed much more severe joint damage, as judged by histological examination and the summed and maximum score analyses (Fig.  1a– d).

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