Should radiographic progression still be used as outcome in RA?

Radiographs of hands and feet are traditionally the images that are used to assess structural damage progression in drug trials in patients with rheumatoid arthritis, aiming at proving the disease modifying capacity of a drug. Although treatment has largely improved over the past decade and consequently radiographic progression is limited in control arms in clinical trials, recent trials are still able to show inhibition of structural progression by new drugs. The requirements for the successful use of radiographic progression as an outcome in rheumatoid arthritis trials will be discussed in this paper