Very recent onset arthritis--clinical, laboratory, and radiological findings during the first year of disease.

OBJECTIVE To describe clinical and radiological findings in patients with very early arthritis (< 3 months of symptoms) during one year of observation. METHODS In an Austrian multicenter setting, patients were eligible if they had nontraumatic swelling or pain in at least one joint and laboratory signs of inflammation [elevated erythrocyte sedimentation rate, C-reactive protein, leukocytosis, or rheumatoid factor (RF)] within the last 3 months. Clinical and laboratory assessments were performed every 3 months. Radiographs of hands and feet were taken at entry and after one year. Treatment decisions were left to the discretion of the participating center. RESULTS In total, 108 patients included between 1996 and 2000 had followup investigations during at least one year; 61.1% of these patients had rheumatoid arthritis (RA). Over 65% of RA diagnoses were made at the first visit. Lag time to referral was significantly longer in patients with RA than in patients with other inflammatory joint diseases (median 8 vs 4 weeks). Disease modifying antirheumatic drugs were started 19 +/- 10 (mean +/- SD) weeks after symptom onset in patients with RA. Patients with RA improved significantly (by American College of Rheumatology response criteria and the Disease Activity Score 28) during the first year. Erosions were present in 12.8% of RA patients' initial radiographs, compared to 27.6% after one year. Odds ratio to develop new erosions during the first year of RA was 9.7 (95% CI 1.05-89.93) in RF+ patients compared to RF- individuals (p < 0.05). CONCLUSION When early referral of patients with arthritis is encouraged, RA can be diagnosed and treatment initiated early, with significant clinical response. Moreover, patients with RA tend to be referred later than patients with other inflammatory joint diseases; RA patients at this very early stage have low frequency of joint damage; and RF predicts erosions in the first year.

[1]  P. Lipsky,et al.  Criteria for early rheumatoid arthritis: from Bayes' law revisited to new thoughts on pathogenesis. , 2002, Arthritis and rheumatism.

[2]  Richard W. Martin,et al.  A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. , 2000, The New England journal of medicine.

[3]  D. M. van der Heijde,et al.  The course of radiologic damage during the first six years of rheumatoid arthritis. , 2000, Arthritis and rheumatism.

[4]  D. Symmons,et al.  Early inflammatory polyarthritis: results from the Norfolk Arthritis Register with a review of the literature. II. Outcome at three years. , 2000, Rheumatology.

[5]  M. Weisman,et al.  When does rheumatoid arthritis begin and why do we need to know? , 2000, Arthritis and rheumatism.

[6]  M. Sanders A review of controlled clinical trials examining the effects of antimalarial compounds and gold compounds on radiographic progression in rheumatoid arthritis. , 2000, The Journal of rheumatology.

[7]  A. Silman,et al.  Does the age of onset of rheumatoid arthritis influence phenotype?: a prospective study of outcome and prognostic factors. , 2000, Rheumatology.

[8]  P. Voulgari,et al.  Influence of cyclosporin A on radiological progression in early rheumatoid arthritis patients: a 42-month prospective study , 2000, Rheumatology International.

[9]  J. Kremer,et al.  Combination Therapy with Multiple Disease-Modifying Antirheumatic Drugs in Rheumatoid Arthritis: A Preventive Strategy , 1999, Annals of Internal Medicine.

[10]  Michael J. Green,et al.  Persistence of mild, early inflammatory arthritis: the importance of disease duration, rheumatoid factor, and the shared epitope. , 1999, Arthritis and rheumatism.

[11]  A. Giobbie-Hurder,et al.  Sulfasalazine treatment for rheumatoid arthritis: a metaanalysis of 15 randomized trials. , 1999, The Journal of rheumatology.

[12]  P. Hannonen,et al.  Comparison of combination therapy with single-drug therapy in early rheumatoid arthritis: a randomised trial , 1999, The Lancet.

[13]  W. Hassfeld,et al.  Sensitivity and specificity of anti-Sa autoantibodies for rheumatoid arthritis. , 1999, Rheumatology.

[14]  T. Pincus,et al.  A proposed 30-45 minute 4 page standard protocol to evaluate rheumatoid arthritis (SPERA) that includes measures of inflammatory activity, joint damage, and longterm outcomes. , 1999, The Journal of rheumatology.

[15]  A. Silman,et al.  The performance of the 1987 ARA classification criteria for rheumatoid arthritis in a population based cohort of patients with early inflammatory polyarthritis. American Rheumatism Association. , 1998, The Journal of rheumatology.

[16]  M. V. van Leeuwen,et al.  Early effective suppression of inflammation in rheumatoid arthritis reduces radiographic progression. , 1998, British Journal of Rheumatology.

[17]  F. Breedveld,et al.  Diagnosis and course of early-onset arthritis: results of a special early arthritis clinic compared to routine patient care. , 1998, British journal of rheumatology.

[18]  F. Breedveld,et al.  Asymptomatic synovitis precedes clinically manifest arthritis. , 1998, Arthritis and rheumatism.

[19]  B. Leeb,et al.  Early arthritis therapy: rationale and current approach. , 1998, The Journal of rheumatology. Supplement.

[20]  P. Jones,et al.  Patterns of radiological progression in early rheumatoid arthritis: results of an 8 year prospective study. , 1998, The Journal of rheumatology.

[21]  M. Alam,et al.  Efficacy of methotrexate in rheumatoid arthritis. , 1997, Bangladesh Medical Research Council bulletin.

[22]  F. Breedveld,et al.  Analysis of the synovial cell infiltrate in early rheumatoid synovial tissue in relation to local disease activity. , 1997, Arthritis and rheumatism.

[23]  M. V. van Leeuwen,et al.  Individual relationship between progression of radiological damage and the acute phase response in early rheumatoid arthritis. Towards development of a decision support system. , 1997, The Journal of rheumatology.

[24]  B. Bresnihan,et al.  Clinical improvement and radiological deterioration in rheumatoid arthritis: evidence that the pathogenesis of synovial inflammation and articular erosion may differ. , 1996, British journal of rheumatology.

[25]  G. Pasero,et al.  Is the control of disease progression within our grasp? Review of the GRISAR study. (Gruppo Reumatologi Italiani Studio Artrite Reumatoide). , 1996, British journal of rheumatology.

[26]  P. Hannonen,et al.  Outcome in patients with early rheumatoid arthritis treated according to the "sawtooth" strategy. , 1996, Arthritis and rheumatism.

[27]  A. van der Heide,et al.  The Effectiveness of Early Treatment with Second-Line Antirheumatic Drugs , 1996, Annals of Internal Medicine.

[28]  F. Breedveld,et al.  Recruitment of patients with early rheumatoid arthritis -- the Netherlands experience. , 1996, The Journal of rheumatology. Supplement.

[29]  G. Stanek,et al.  Reactive arthritis: urogenital swab culture is the only useful diagnostic method for the detection of the arthritogenic infection in extra-articularly asymptomatic patients with undifferentiated oligoarthritis. , 1995, British journal of rheumatology.

[30]  F. Breedveld,et al.  Validity and reliability of the twenty-eight-joint count for the assessment of rheumatoid arthritis activity. , 1995, Arthritis and rheumatism.

[31]  H. Capell Clinical efficacy of sulphasalazine--a review. , 1995, British journal of rheumatology.

[32]  M. Prevoo,et al.  Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. , 1995, Arthritis and rheumatism.

[33]  O. Førre Radiologic evidence of disease modification in rheumatoid arthritis patients treated with cyclosporine. Results of a 48-week multicenter study comparing low-dose cyclosporine with placebo. Norwegian Arthritis Study Group. , 1994, Arthritis and rheumatism.

[34]  A M Walker,et al.  The lag time between onset of symptoms and diagnosis of rheumatoid arthritis. , 1994, Arthritis and rheumatism.

[35]  B. Dijkmans,et al.  A randomized, double-blind, 24-week controlled study of low-dose cyclosporine versus chloroquine for early rheumatoid arthritis. , 1994, Arthritis and rheumatism.

[36]  J. McDonagh,et al.  Differentiating persistent from self-limiting symmetrical synovitis in an early arthritis clinic. , 1993, British journal of rheumatology.

[37]  T. Pincus,et al.  The paradox of effective therapies but poor long-term outcomes in rheumatoid arthritis. , 1992, Seminars in arthritis and rheumatism.

[38]  M. A. van 't Hof,et al.  Biannual radiographic assessments of hands and feet in a three-year prospective followup of patients with early rheumatoid arthritis. , 1992, Arthritis and rheumatism.

[39]  D A Bloch,et al.  The progression of erosion and joint space narrowing scores in rheumatoid arthritis during the first twenty-five years of disease. , 1991, Arthritis and rheumatism.

[40]  G. Alarcón,et al.  Suppression of rheumatoid factor production by methotrexate in patients with rheumatoid arthritis. Evidence for differential influences of therapy and clinical status on IgM and IgA rheumatoid factor expression. , 2010, Arthritis and rheumatism.

[41]  P. Lipsky,et al.  Correlation of serologic indicators of inflammation with effectiveness of nonsteroidal antiinflammatory drug therapy in rheumatoid arthritis. , 1990, Arthritis and rheumatism.

[42]  D. Heijde,et al.  EFFECTS OF HYDROXYCHLOROQUINE AND SULPHASALAZINE ON PROGRESSION OF JOINT DAMAGE IN RHEUMATOID ARTHRITIS , 1989, The Lancet.

[43]  T. Pincus,et al.  A simplified twenty-eight-joint quantitative articular index in rheumatoid arthritis. , 1989, Arthritis and rheumatism.

[44]  T. Vischer,et al.  OM-8980 in rheumatoid arthritis: a 6-month double blind placebo controlled multicenter study. , 1989, The Journal of rheumatology.

[45]  M. Liang,et al.  The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. , 1988, Arthritis and rheumatism.

[46]  A. Masi Articular patterns in the early course of rheumatoid arthritis. , 1983, The American journal of medicine.

[47]  A. Linos,et al.  The epidemiology of rheumatoid arthritis in Rochester, Minnesota: a study of incidence, prevalence, and mortality. , 1980, American journal of epidemiology.

[48]  A. Larsen,et al.  Radiographic Evaluation of Rheumatoid Arthritis and Related Conditions by Standard Reference Films , 1977, Acta radiologica: diagnosis.

[49]  G. A. Bennett,et al.  1958 Revision of diagnostic criteria for rheumatoid arthritis. , 1959, Bulletin on the rheumatic diseases.