A Prognostic Index for Erosive Changes in the Hands, Feet, and Cervical Spines in Early Rheumatoid Arthritis

Abstract

Clinical and laboratory measurements taken at the onset of rheumatoid arthritis in 149 patients were compared with the severity of radiological changes seen at 3 years in the hands and feet, and cervical spine. The strongest association with the severity of peripheral radiological damage was rheumatoid factor (p less than 0.0001 for both the latex titre and RAHA titre). Subluxation of the cervical spine was associated only with the presence of HLA-Dw2 (p less than 0.02) and HLA-B7 cross-reacting group (p less than 0.02). Discriminant function analysis utilizing latex titre, RAHA titre, haemoglobin level, and platelet count predicted the development of erosive or nonerosive disease in 79%. This method was less successful in predicting the actual severity of erosive damage and was not improved by the addition of HLA data. Radiological outcome in the cervical spine was successfully predicted in 82% using HLA-Dw2, HLA-B27 and age of onset of disease. It is concluded that the best predictors of erosive disease were standard laboratory features measured at onset, but that more powerful discriminant factors are needed if these are to influence clinical practice. Further prospective studies will establish whether rheumatoid involvement of the cervical spine is an expression of the influence of HLA determinants in this disease.

The radiographic features of rheumatoid arthritis in HLA-B27-positive patients

“…Men are more commonly affected than women, although this may represent the sex-related expression of HLA-B27 spondyloarthropathy. Clinically, patients often exhibit features of both classical RA and spondyloarthropathy, and are occasionally defined as having the" overlap syndrome" [12]. Patients more frequently have symptoms of cervical spine or sacroiliac joint pain than do patients with RA alone.…”

“…Fallahi et al [6] in a review of 292 patients with RA found that the presence of the HLA-B27 antigen did not alter the radiographic picture regarding joint distribution, pattern and mode of onset, disease progression, and the rate of occurrence of postoperative heterotopic ossification. However, several other reports suggest an increased incidence of sacroiliac joint involvement in HLA-B27-positive RA patients [3,4,12]. Most recently, Jurik et al [9] examined a group of 11 HLA-B27-positive, seropositive RA patients and age-matched B27-negative control patients.…”

“…Patients with classic rheumatoid arthritis who also possess the HLA-B27 antigen have been reported in the rheumatologic literature [1-4, 7, 8, 10, 11]. The radiographic features in these patients remain in doubt and have been only briefly discussed in the rheumatologic or radiologic literature [3,4,6,9,12]. The goal of this study was to further elucidate these radiographic characteristics in the hope of finding unique signs that might facilitate recognition of this subgroup.…”

Early and extensive erosiveness in peripheral joints predicts atlantoaxial subluxations in patients with rheumatoid arthritis

“…The rheumatoid disorders of the cervical spine are known to be associated with the extent of erosions in the peripheral joints and the HLA status, as well as with the presence of rheumatoid factor (RF) and rheumatoid nodules (6)(7)(8)(9)(10). Continuous disease activity predicts the development of erosions in peripheral joints (11,12).…”

Agalactosyl IgG: An aid to differential diagnosis in early synovitis

“…However, of these and other features analyzed in a study using discriminant function analysis, only a combination of RF (by sheep cell agglutination and by latex fixation), hemoglobin level, and platelet count successfully predicted radiologic outcome in 72%. This was confirmed in 79% in a separate group (19). Improvement in these values is essential to the clinician intending to use powerful second-line agents in early disease.…”