Fleming, A., Crown, J. M., and Corbett, M. (1976). Annals of the Rheumatic Diseases, 35, 357-360. Early rheumatoid disease. L. Onset. We describe features with onset in 102 patients seen within the first year of rheumatoid disease. The male:female ratio was approximately 3:4, suggesting a near equal sex incidence at onset. The disease started more often in the colder months and was usually insidious, symmetrical, and involved the upper limbs.The patients were followed prospectively and outcome was assessed after a mean of 4 5 years. Older patients fared worse and there was a trend for a poorer prognosis to be indicated by an insidious onset and early progression to symmetrical involvement.The importance of observing all phenomena associated with onset in a condition such as rheumatoid disease, where cause and cure are unknown, has been stressed by Jacoby, Jayson, and Cosh (1973). Studies attempting this rely on patient memory, and a defect of many such works has been the length of time after which patients have been asked to recall early episodes. It is difficult to find and follow rheumatoid sufferers early in the course of their disease, and as a result only a few reports are based on data obtained near the onset of joint symptoms (Otten and Boerma, 1959; Rotes-Querol and RoigEscofet, 1968; Jacoby and others, 1973).A recent prospective study of early rheumatoid disease, undertaken at the Middlesex Hospital, has provided information on various aspects of onset, including age, sex, time, type, site, symmetry, and time-lag to presentation, enabling the significance of these data to be assessed in relation to other disease features and to subsequent course. The information was taken at a mean 4-6 months from onset, when patient memory was relatively fresh.Patients and methods Patients were invited to enter the study if the rheumatologist suspected rheumatoid disease of less than one year's duration. Those with evidence of psoriatic arthritis, gout, ankylosing spondylitis, Reiter's disease, or colitic arthropathy were excluded. At this first specialist rheumatological consultation the historical data on onset was gathered. The patient subsequently attended a special research clinic three times a year.At the special clinic the site of involvement (swelling, tenderness, or pain on movement) was noted, the rheumatoid status was recorded (American Rheumatism Association, 1959), and the patient was placed in one of four functional grades (Duthie and others, 1955). Annual radiographs were taken of hands, feet, and cervical spine, and the presence of erosions was recorded. The sheep cell agglutination test (SCAT) was used to estimate rheumatoid factor (Roitt and Doniach, 1969). The clinics were quite distinct from the regular outpatient visits and treatment was not influenced.One hundred and two patients were studied, and were followed in the clinic for 18 months or longer, or until death. The mean delay from onset to the first specialist consultation and to the first research clinic visit was respectively 4 6 months ...
