Rheumatology Advance Access originally published online on August 9, 2006
Rheumatology 2007 46(2):342-349; doi:10.1093/rheumatology/kel237
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© 2006 The Author(s)
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Very recent onset rheumatoid arthritis: clinical and serological patient characteristics associated with radiographic progression over the first years of disease
1Department of Rheumatology, Medical University of Vienna and 22nd Medical Department, Hietzing Municipal Hospital, Vienna, Austria, 3Mark O Hatfield Clinical Research Center, NIAMS/NIH, Bethesda, USA and 4Department of Radiology, Medical University of Vienna, Vienna, Austria.
Correspondence to: Klaus P. Machold, Department of Rheumatology, Medical University of Vienna, Vienna, Austria. Email: Klaus.machold{at}meduniwien.ac.at
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Abstract |
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Objectives. Despite early recognition and disease modifying anti-rheumatic drug (DMARD) treatment, a sizable proportion of early rheumatoid arthritis (RA) patients show radiological progression. This study was performed to determine the frequency of erosive arthritis and the pace of radiological progression in an inception cohort of patients with very early RA (
3 months after onset of symptoms).
Methods. In order to determine possible prognostic factors for development of erosive disease, we linked the clinical features of these patients to radiological progression in a regression model. About 55 patients with RA and follow-up of at least 3 yrs were analysed. All had complete series of clinical, serological and radiographic assessments. Radiographs were scored according to the Larsen method.
Results. Erosive disease developed in 63.6% of the patients over 3 yrs, with the majority (74.3%) appearing already in the first and 97.2% by the end of the second year. Among all variables available, rheumatoid factor (RF) and/or anti-cyclic citrullinated peptide (anti-CCP) first presentation were the most predictive for both development of erosions and the degree of radiological progression. None of the clinical variables at the onset was useful to discriminate between erosive and non-erosive patients. In the final regression model, however, cumulative clinical activity substantially contributed to explaining radiological progression.
Conclusion. Despite early treatment, substantial damage occurred in some patients and was associated with presence of strong ‘constitutive’ predictors such as anti-CCP and RF as well as presence of high long-term clinical disease activity as indicated by C-reactive protein (CRP), swollen joint counts and the absence of a good clinical response (assessed by the failure to achieve lasting low disease activity).
KEY WORDS: Very early rheumatoid arthritis, Determinants of radiographic progression, Disease control
Submitted 19 February 2006;
revised version accepted 2 June 2006.
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