ObjectivesFatigue is a frequent symptom in rheumatoid arthritis (RA) and has high impact on quality of life. We explored associations between disease activity and fatigue in patients with early RA during the initial 24 months of modern treat-to-target therapy and predictors of fatigue after 24 months of follow-up.MethodsData were obtained from the treat-to-target, tight control Aiming for Remission in Rheumatoid Arthritis: a Randomised Trial Examining the Benefit of Ultrasound in a Clinical Tight Control Regime (ARCTIC) trial. Fatigue was measured on a visual analogue scale (VAS) from 0 to 100 mm and defined as clinically relevant if VAS was ≥20 mm. Baseline predictors of fatigue at 24 months were analysed by multivariable logistic regression.Results205 patients with fatigue data at baseline and 24 months were included. Median (25th, 75th percentiles) symptom duration was 5.4 months (2.8, 10.4), fatigue VAS 37.0 mm (13.0, 62.0) and mean Disease Activity Score (DAS) 3.4 (SD 1.1) at baseline. Prevalence of fatigue declined from 69% at baseline to 38% at 24 months. Fewer swollen joints (OR 0.92, 95% CI 0.87 to 0.98, p=0.006), lower power Doppler ultrasound score (OR 0.95, 95% CI 0.90 to 0.99, p=0.027) and higher patient global assessment (PGA) (OR 1.03, 95% CI 1.01 to 1.04, p<0.001) increased the risk of clinically relevant fatigue at 24 months. Not achieving remission at 6 months was associated with a higher risk of reporting fatigue at 24 months.ConclusionsFatigue in patients with early RA was prevalent at disease onset, with a rapid and sustained reduction during treatment. Low objective disease activity and high PGA at baseline were predictors of clinically relevant fatigue at 24 months.

ObjectivesTo investigate if inflammation detected by MRI or ultrasound at rheumatoid arthritis (RA) onset is predictive of erosive progression or poor response to methotrexate monotherapy, and to investigate if subclinical inflammation in remission is predictive of future treatment escalation or erosive progression.MethodsIn a 2-year study, 218 patients with disease-modifying antirheumatic drug-naïve early RA were treated by a tight-control treat-to-target strategy corresponding to current recommendations. MRI and ultrasound were performed at regular intervals. Baseline imaging-based inflammation measures were analysed as predictors for early methotrexate failure and erosive progression using univariate and multivariate regression adjusted for clinical, laboratory and radiographic measures. In patients in remission after 1 year, imaging measures were analysed as predictors of treatment escalation and erosive progression during the second year. The added value of imaging in prediction models was assessed using receiver operating characteristic analyses.ResultsBaseline MRI inflammation was associated with MRI erosive progression and ultrasound with radiographic erosive progression. No imaging inflammation measure was associated with early methotrexate failure. Imaging inflammation was present in a majority of patients in clinical remission. Tenosynovitis was associated with treatment escalation, and synovitis and tenosynovitis with MRI/radiographic erosive progression during the second year. Imaging information did not improve prediction models for any of the outcomes.ConclusionsImaging-detected inflammation, both at diagnosis and in remission, is associated with elements of future disease development. However, the lack of a significant effect on prediction models indicates limited value of systematic MRI and ultrasound in management of early RA.

BackgroundWith implementation of tight control strategies and defined treatment targets in rheumatoid arthritis (RA) care, a majority of early RA patients may reach remission and traditional predictors of joint damage might no longer be present.ObjectivesTo identify baseline parameters predictive of 2-year radiographic progression in an early RA population treated by a semi-personalized treat-to-target strategy.MethodsDMARD naïve RA patients with <2 years from first swollen joint were included in the ARCTIC study. Patients were followed for 24 months with DAS, radiographs and ultrasound (32 joints, each scored 0–3 for gray-scale (GS) and power-Doppler (PD)). Patients were treated according to an aggressive algorithm with treatment target of DAS <1.6 and SJC44=0, and in half the patients, absence of ultrasound PD signal. Patients with risk factors for progressive joint destruction (ACPA or RF positive with baseline erosions, or MRI bone marrow edema) could be escalated more aggressively to biologics. Radiographs were scored by two readers using the van der Heijde-Sharp method, with cut-off ≥1 unit change/year to be classified as progression. The SDC was 1.94 units. Potential baseline predictors were analyzed for collinearity, and remaining variables (gender, age, smoking, BMI, disease duration <3 months, ACPA, RF, tender joints, 44 SJC, ESR, total GS-score, total PD-score, patient global and radiographic joint damage) assessed by univariate logistic regression. Variables with p<0.25 from the univariate analysis were included in the multivariate model building, and a p-value of <0.05 was required to remain in the model.ResultsMean [SD] age of the 222 patients was 51.1 [13.7] years, disease duration 7.2 [5.4] months, and mean DAS 3.5 [1.2]. 63% were female, 72% RF and 82% ACPA positive. 92 (41%) had radiographic progression at 24 months, and 68% were in DAS remission at 24 months. In 16% of patients treatment was escalated more rapidly from MTX monotherapy to biologics due to baseline risk factors. Smoking, tender joints, 44 SJC, ESR, PD-score, age and gender had a univariate p-value<0.25 but did not remain in the final model. In the multivariate model, RF positivity (OR 2.27, p-value 0.022), total van der Heijde Sharp score (OR 1.08, p-value 0.017) and ultrasound GS score (OR 1.03 per unit, p-value 0.019) were independent baseline predictors for radiographic progression at 24 months (table).Table 1.Multivariate model for baseline predictors of radiographic progression at 24 months. Model corrected for age and genderBaseline variablesRadiographic progression at 24 months (n=92/222)UnivariateMultivariateOR [CI]P-valueOR [CI]P-valueUS GS-score (0–96)1.03 [1.01, 1.05]0.0051.03 [1.00, 1.05]0.019RF positivity (IgM/IgA)1.78 [0.96, 3.29]0.072.27 [1.13, 4.57]0.022Total van der Heijde Sharp score1.11 [1.06, 1.17]<0.0011.08 [1.01, 1.14]0.017ConclusionsRF positivity, radiographic joint damage and ultrasound gray-scale score were independent baseline predictors of joint damage in early RA patients treated according to an aggress...

No abstract