Our results did not show LORA as a separate subgroup of RA with a different prognosis with regard to radiographic progression.

New American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria for the classification of rheumatoid arthritis (RA) have recently been proposed. The aim of this cohort study was to examine whether fulfilling these 2010 ACR/EULAR criteria at the first visit has an impact on the clinical course and on the radiographic progression of the disease. For this observational cohort study, we included patients from the Swiss RA registry SCQM with early RA or undifferentiated arthritis (UA, disease duration ≤1 year), as defined by the treating rheumatologist, who had not received any previous disease modifying anti-rheumatic drugs (DMARDs). Patients were categorized into two groups depending on whether or not they fulfilled the 2010 ACR/EULAR criteria (≥6 points vs <6 points) at the first visit. The primary outcome measures were the evolution of the DAS 28 and of radiographic erosions as measured by the Ratingen score over time. Of the 592 patients fulfilling the inclusion criteria, 352 satisfied the 2010 ACR/EULAR criteria at baseline, whereas 240 were not classifiable as definite RA. The ACR/EULAR criteria scores correlated with disease activity at disease onset (R (2) = 0.31). DMARD treatment was subsequently initiated in all patients, mostly with methotrexate (MTX). There were no significant differences in the therapeutic strategies between patients fulfilling or not fulfilling the classification criteria. Six months after inclusion, patients fulfilling the ACR/EULAR criteria developed a 39.1 % reduction of DAS 28 scores, as compared to a 33.6 % reduction in patients not fulfilling the ACR/EULAR criteria (p = 0.0002), independently of their respective treatment strategy. Importantly, the DAS 28 scores were higher in those patients fulfilling the ACR/EULAR criteria (ACR/EULAR positive patients) throughout the observation, as compared to patients not fulfilling those (ACR/EULAR negative patients). Average radiographic progression was higher among ACR/EULAR positive than negative patients (progression of Ratingen score/year 0.50 vs 0.32, resp., p = 0.03) after 3 years of follow-up. Among early RA/UA patients, a score of the 2010 ACR/EULAR criteria sufficient to classify RA selects patients with worse clinical outcome and more radiographic progression.

ObjectiveTo analyse whether early arthritis patients who do not fulfil the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2010 classification criteria for rheumatoid arthritis (RA) have a different course of the disease dependent on whether they can or cannot be classified as RA because of radiographic disease (EULAR task force) at diagnosis.MethodsFor this observational study within the Swiss RA cohort SCQM, we included patients with early undifferentiated arthritis (disease duration ≤1 year), who had not received any previous disease-modifying antirheumatic drugs (DMARDs). 2010 ACR/EULAR criteria negative patients were separated into two groups (radiographic vs non-radiographic arthritis) depending on whether or not they had radiographic changes defined as erosive disease by a EULAR task force (≥3 joints with erosions). The primary outcome measure was the radiographic progression detected employing the Ratingen erosion score. Health Assessment Questionnaire (HAQ) and DAS-28 were used as secondary outcome measures. The average observation period was 4 years.ResultsA total of 592 patients were analysed. 240 were not classifiable as RA by application of the 2010 ACR/EULAR criteria at baseline. In 57 patients, radiographs at the first visit were not available. 133 patients had radiographic arthritis and 50 non-radiographic arthritis. Treatment was initiated in all patients with DMARDs, mostly methotrexate. No differences in DAS-28 and HAQ scores were found during follow-up. The average erosion scores were higher among patients with initially radiographic arthritis throughout the study. The progression of erosion scores over time, however, was higher in patients with initially non-radiographic arthritis with less subsequent radiological progression (3.3 erosions/year vs 0.4, respectively, p<0.0001).ConclusionsThe clinical and radiographic course of early undifferentiated arthritis under treatment was not dependent on the presence of erosions in three or more joints (ie, the definition of radiographic disease by the EULAR task force) at diagnosis in our cohort.

The main goal of this study was to analyse whether initial addition of glucocorticoid to DMARD therapy influences the long-term course of the disease in patients with early rheumatoid arthritis. All patients from the Swiss RA cohort SCQM with recent-onset arthritis (disease duration ≤1 year) were analysed. The exposure of interest was the use of glucocorticoids (GCs) at baseline. As primary outcome, we considered clinical and radiographic disease progression, assessed by the disease activity (disease activity score, DAS-28), function (health assessment questionnaire disability index, HAQ-DI) and structural joint damage (Ratingen erosion score). The baseline disease characteristics were compared using standard descriptive statistics. The effects of initial GC use on disease progression during follow-up were estimated using linear mixed models with random slope and random intercept, adjusted for potential confounders. In total, 592 patients with early disease were available, with 4.3 years of follow-up (average). Of these, 363 were initially treated with glucocorticoids (GC patients) and 228 were not (no-GC patients). DAS-28 (4.6 vs. 4.3, p = 0.01) and the HAQ-DI (0.94 vs. 0.82, p = 0.01) were higher at baseline in GC patients, while other prognostic factors were balanced at baseline. Neither the change of DAS-28, of HAQ-DI nor of the development of joint erosions differed between the two groups during follow-up. Escalation of treatment employing biologics was documented in 18.0% of the no-GC patients and 27.3% of the GC patients (p < 0.01). In this cohort, patients with early RA initially treated with GCs had higher measures of disease activity at baseline in comparison to no-GC patients. Despite a similar course of the disease in GC versus non-GC patients, the higher escalation rate to biologic agents in GC patients may reflect a disease less responsive to therapy in these patients. These data suggest that GC use as part of the initial therapeutic strategy in early RA may prevent a more severe course of the disease in patients with higher clinical disease measures at the start of therapy.

Background Rheumatoid arthritis (RA) is generally described as a disease with two peaks of onset, either late (late onset RA, LORA) or early (young onset RA, normal 30-55 years, YORA). Considering that the average age of the population is continuously rising, LORA will gain importance in the near future. Despite this growing importance LORA has not been the focus of much interest in the past. Objectives This study was set up to analyse disease activity and progression in LORA in comparison to YORA patients with early disease. Methods This is a cohort study within the Swiss RA registry SCQM. We included all patients with recent onset arthritis, either RA (disease duration ≤1 year) or undifferentiated, as diagnosed by the data-entering physician. Patients were followed up to 5 years. The cut off between YORA and LORA was operationally set at 60 years of age. Disease progression and activity was assessed based on DAS 28 and the progression of joint erosions using the Ratingen score. Results A total of 592 patients with early undifferentiated or RA was analysed. The age at disease onset had a Gaussian distribution, with a single peak at 60 years of age. 366 patients were 60 years or younger (YORA) and 226 patients were older (LORA) at disease onset. DAS 28 scores were significantly higher among LORA as compared to YORA patients (4.8 vs. 4.5, p = 0.049). Corticosteroids were used in 68% of LORA patients as a first line treatment, compared to 25.4% in YORA patients (X2 test, p < 0.0001). DMARDs, on the other hand, were used in 100% of the YORA patients as first line treatment compared to 91.2% of the LORA patients. During follow up, new glucocorticoid, synthetic, or biologic DMARD were initiated in 32.8%/61.1%/14.1% of all decisions documented among YORA patients and 17.5%/54.6%/6.6% in LORA patients (X2 test, all p < 0.0001. The DAS28 scores decreased in both groups over the observed time period, and the initial differences in disease activity vanished after 1/2 year and during the subsequent follow up. The Ratingen score was higher in LORA than in YORA patients at inclusion (12.7 vs. 5.6, p < 0.0001). The rate of radiological progression at 5 years was similar comparing LORA and YORA (3.3 vs. 2.6, resp., p=0.64). The level of Ratingen scores at onset and during follow up over 5 years did not clearly separate LORA and YORA into two groups), but rather increased linearly when comparing the patients in groups per decade from 20 to 92 years of age. References Our results do not support the existence of a separate LORA subgroup with a distinct peak of incidence and/or course of the disease. Disclosure of Interest None Declared