Clinical course and outcome of early rheumatoid arthritis

Ia, Papadopoulos; Katsimbri, Pelagia; Katsaraki, Afroditi; Temekonidis, T I; Georgiadis, A.; Aa, Drosos

doi:10.1007/s002960100106

Cited by 13 publications

(4 citation statements)

References 28 publications

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“…In addition, earlier studies frequently showed that seropositive RA with high titers of autoantibodies and high CRP values at diagnosis are associated with more destructive disease with poorer outcome. 27 – 29 In the present study, seropositivity was significantly less common in the subjective group. This indicates that patients in the subjective group had good prognosis in average, and there would not be a great need for treatment intensification; however, DAS28 was higher than 3.2.…”

Section: Discussionsupporting

confidence: 44%

The Reliability of Disease Activity Score in 28 Joints–C-Reactive Protein Might Be Overestimated in a Subgroup of Rheumatoid Arthritis Patients, When the Score Is Solely Based on Subjective Parameters

Hansen¹,

Andreasen²,

Hansen³

et al. 2017

J Clin Rheumatol

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BackgroundDisease Activity Score in 28 Joints (DAS28) is a scoring system to evaluate disease activity and treatment response in rheumatoid arthritis (RA). A DAS28 score of greater than 3.2 is a well-described limit for treatment intensification; however, the reliability of DAS28 might be overestimated.ObjectiveThe aim of this study was to evaluate the reliability of DAS28 in RA, especially focusing on a subgroup of patients with a DAS28 score of greater than 3.2.MethodsData from RA patients registered in the local part of Danish DANBIO Registry were collected in May 2015. Patients were categorized into 2 groups: First, those with DAS28 >3.2 with at least one swollen joint (SJ) or elevated C-reactive protein (CRP) (“objective group”), and second, patients with a DAS28 >3.2 who had no SJ, and CRP values were within the reference range (“subjective group”). Disease Activity Score in 28 Joints, Clinical Disease Activity Index, and Health Assessment Questionnaire scores were calculated for each group. We defined new score, DAS28 subjective, to focus on subjective parameters.ResultsTwo hundred thirty patients were included; 198 (86.1%) and 32 (13.9%) patients were in the objective and subjective groups, respectively. Patients in the subjective group had lower mean values of DAS28 (P < 0.001) and Evaluator Global Assessment (P < 0.001) with less common immunoglobulin M rheumatoid factor (P < 0.001) and anti–cyclic citrullinated peptide positivity (P = 0.02) and contrarily higher mean values of tender joints (P = 0.04) and DAS28 based on subjective parameters (P = 0.003) compared with the objective group.ConclusionsRheumatoid arthritis scoring systems should be used cautiously in patients who are considered for treatment intensification. Patients with central sensitization and psychological problems and those with false-positive diagnosis of RA are at high risk of overtreatment.

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Section: Discussionsupporting

confidence: 44%

The Reliability of Disease Activity Score in 28 Joints–C-Reactive Protein Might Be Overestimated in a Subgroup of Rheumatoid Arthritis Patients, When the Score Is Solely Based on Subjective Parameters

Hansen¹,

Andreasen²,

Hansen³

et al. 2017

J Clin Rheumatol

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“…From a study by Papadopoulos et al in Greece, male-female ratio, age at diagnosis, disease duration, and morning stiffness were not significantly different between seropositive and seronegative groups. However, seropositive patients had a longer follow-up period, more frequent involvement of hand joint, and higher involved joint counts than the seronegative group 9. Furthermore, a report indicated that rheumatoid nodule was highly reported in seropositive patients 10.…”

Section: Discussionmentioning

confidence: 98%

“…Regarding RA treatment according to RF presence, Papadopoulos et al reported a high frequency of hydroxychloroquine, D-penicillamine, and methotrexate in seropositive patients 9. In a prospective study for an average of 6.2 years, Mottonen et al reported that RA patients used 3.3 DMARDs on average 18.…”

Section: Discussionmentioning

confidence: 99%

Rheumatoid Factor is a Marker of Disease Severity in Korean Rheumatoid Arthritis

et al. 2005

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Serum rheumatoid factor (RF) is important in the diagnosis and prognosis of rheumatoid arthritis (RA). The purpose of this study is to compare the clinical characteristics and treatment patterns of RA according to the presence of RF in Korean patients. A retrospective analysis was performed on the records of 109 patients who were followed for at least 2 years, among 230 RA patients who visited at the rheumatology clinic in Ajou University Hospital and who fulfilled the 1987 revised American College of Rheumatology criteria for RA. Sixty-four patients were RF positive (58.7%) and 91 patients were female (83.5%). There was no significant difference in demographic characteristics, joint involvements, or percentage of morning stiffness between seropositive and seronegative groups. Anti-nuclear antibody was detected more frequently in the seropositive group (p<0.05). At initial diagnosis, the seropositive group had higher white blood cell and platelet counts than the seronegative group (p<0.01). However, the difference was disappeared at the last follow-up. Inflammatory markers such as ESR and CRP were also higher at diagnosis in the seropositive group (p<0.01). These inflammatory markers were still greater than the seronegative group at the last follow-up (p<0.01). There was no significant difference in the use of disease modifying antirheumatic drug (DMARD) and steroid dosage between groups. However, DMARD combination therapy was more commonly used in the seropositive group (p<0.05), especially triple DMARD combination. These results suggest that disease activity is more severe in the seropositive than the seronegative group, and more aggressive treatments are needed in the seropositive group.

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“…Rheumatoid arthritis (RA) is a progressive autoimmune disease characterized by inflammatory activity in the joints, synovial sheets of tendons and bursae as well as extra-articular manifestations such as vasculitis and serositis [1-3]. The increased amount of pro-inflammatory cytokines mediates osteoclast activation, which in turn provokes joint destruction [4].…”

Section: Introductionmentioning

confidence: 99%

Does digital X-ray radiogrammetry have a role in identifying patients at increased risk for joint destruction in early rheumatoid arthritis?

et al. 2012

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IntroductionThe aim of this study was to investigate the role of hand bone mineral density (BMD) loss analyzed with digital X-ray radiogrammetry (DXR) in early rheumatoid arthritis (RA) as a predictor for progression of joint damage.MethodsIn 379 patients with early RA, baseline and one-year hand BMD was measured with DXR and the hand bone loss (HBL) was analyzed using the smallest detectable change (HBLsdc) and tertiles (HBLtertiles). Joint damage in hands and feet were scored according to the Sharp van der Heijde (SHS) method at baseline and at one, two, five and eight years. At the same time-points Disease Activity Score (DAS28) was calculated and functional disability assessed. Rheumatoid factor (RF) and antibodies against cyclic citrullinated peptides (anti-CCP) were analyzed at baseline.ResultsSixty-six percent of the patients had hand BMD loss in the first year of RA determined by HBLsdc and 65% by HBLtertiles. Radiographic progression after two, five and eight years was associated with hand bone loss defined by HBLsdc. By HBLtertiles there were significant associations at all time-points except at eight years. The change in DXR at one year (ChDXR1yr) correlated significantly and inversely with the change in SHS (ChSHS) at two, five and eight years. Multivariate analysis showed that only change in SHS during the first year and the presence of anti-CCP were independent predictors of long-term progressive joint damage. If radiographic scores were not included, DXR-BMD loss was an independent predictor. Patients with great bone loss by HBLtertiles had significantly more often high disease activity after two years. However, neither bone loss by HBLsdc or HBLtertiles nor by ChDXR1yr was an independent predictor of remission after two, five and eight years.ConclusionsThis study confirms previous reports of an association of decrease in DXR-BMD during the first disease year with progression of radiographic joint damage over an extended period of time. This association was independent in a regression model only when radiological findings were excluded suggesting a possible predictive role of DXR-BMD in clinical practice when radiographic evaluation is not available. However, further studies are required before this can be established.

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Clinical course and outcome of early rheumatoid arthritis

Cited by 13 publications

References 28 publications

The Reliability of Disease Activity Score in 28 Joints–C-Reactive Protein Might Be Overestimated in a Subgroup of Rheumatoid Arthritis Patients, When the Score Is Solely Based on Subjective Parameters

The Reliability of Disease Activity Score in 28 Joints–C-Reactive Protein Might Be Overestimated in a Subgroup of Rheumatoid Arthritis Patients, When the Score Is Solely Based on Subjective Parameters

Rheumatoid Factor is a Marker of Disease Severity in Korean Rheumatoid Arthritis

Does digital X-ray radiogrammetry have a role in identifying patients at increased risk for joint destruction in early rheumatoid arthritis?

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