BackgroundRecent-onset inflammatory arthritis (IA) may represent a broad range of diseases. Few studies have examined the full spectrum of diagnostic outcomes in an unselected cohort of recent-onset IA patients.ObjectivesTo describe the disease spectrum and 2-year outcome of recent onset IA in a large multicenter study in Norway.MethodsData from the Norwegian Very Early Arthritis Clinic (NOR-VEAC), a 2-year longitudinal observational study of 1118 patients (age 18–75 yrs) with inflammatory arthritis of ≤16 weeks duration, were used. Exclusion criteria were arthritis due to crystal deposits, trauma, osteoarthritis and septic arthritis. Herein we included all patients with follow-up information. Descriptive methods were applied to describe the whole range of diagnostic outcomes (clinical diagnoses made by the treating rheumatologist), as well as disease persistency (defined as disease modifying anti-rheumatic drug (DMARD) use and/or persistent joint swelling) vs resolution of disease for each clinical diagnosis. Patients with temporary DMARD use were classified as no-DMARD users if they were observed for ≥1 year after DMARD cessation. If a patient dropped out of the study before 2 years, the last outcome information was used in a last observation carried forward approach.Results1077 patients (96.3%) were included in the current analyses, of these 64.9% had 2-year follow-up data. Duration of joint swelling before inclusion [median (25–75 perc.)] was 34 (13–66) days, mean (SD) age 46.1 (14.8) years, 54.7% were females, 16.9% anti-CCP positive, and 21.9% anti-CCP and/or RF positive. Presentation as mono-, oligo- (2–4 swollen joints), and polyarthritis (≥5 swollen joints) had approximately the same frequency, 32.5, 35.7 and 31.8%, respectively.After 2 years 33.0% used DMARDs, and a further 9.3% had joint swelling without DMARD use. The arthritis resolved in the remaining 57.6%. The final clinical diagnoses and their respective outcomes are shown in Figure 1. The most common final diagnoses were undifferentiated arthritis (UA) (39.9%), rheumatoid arthritis (RA) (22.7%), reactive arthritis (17.1%), psoriatic arthritis (6.0%) and sarcoid arthropathy/Löfgren's syndrome (6.2%). A final diagnosis of sarcoid arthropathy, reactive arthritis and UA carried the best prognoses, with resolution of arthritis without DMARDs in 91.0, 85.9 and 73.7%, respectively. Patients presenting with polyarthritis developed persistent disease more often than patients with oligo- or monoarthritis (67.6%, 34.9 and 26.0%, respectively) (p<0.001).ConclusionsAmong 1077 patients with IA of ≤16 weeks duration, UA was the most common diagnosis after 2 years, 22.7% were diagnosed with RA and 6.0% with psoriatic arthritis. The arthritis resolved without DMARDs in the majority of the patients. This is, as far as we know, the first study to describe the whole range of diagnostic outcomes in an unselected cohort of recent-onset arthritis, as well as the persistency of disease according to each diagnosis.Disclosure of InterestE. S. Norli: None declared, G. Hetl...
BackgroundMusculoskeletal disorders, including inflammatory arthritis (IA), are among the most common reasons for work disability and sick leave. Early IA patients with risk factors for persistent and/or erosive disease, such as high swollen joint count (SJC), acute-phase reactants, RF- or ACPA-positivity, are treated aggressively to prevent joint damage and disability.ObjectivesTo study the rate of sick leave according to clinical diagnosis in an unselected very early IA cohort, and to investigate whether the predictors for sick leave are the same as the known predictors for persistent and/or erosive disease.MethodsData from the Norwegian Very Early Arthritis Clinic (NOR-VEAC), a longitudinal observational study of adults with IA of ≤16 weeks' duration, were used. Exclusion criteria were arthritis due to crystal deposits, trauma, osteoarthritis and septic arthritis. For the present study we included patients eligible for work participation, i.e. <65 years with no retirement or disability pension, who had information about work in the baseline and six-month case report forms. Independent samples t-test, Mann-Whitney-U test or chi-square test were used as appropriate to compare patients on sick leave after 6 months with patients not reporting sick leave. Clinically relevant baseline variables with univariate p-value <0.2, as well as age and sex, were included in the multivariable logistic regression analyses with manual backwards selection to find predictors for sick leave after six months.ResultsOf 880 patients eligible for analysis (<65 years, no retirement or disability pension), 664 (75.5%) had complete work participation data. Duration of joint swelling before inclusion [median (25–75 perc.)] was 35 (14–69) days, mean (SD) age 42.1 (12.1) years, 56.0% were females, 27.3% current smokers, and 22.4% anti-CCP and/or RF positive. The most common final clinical diagnoses were undifferentiated arthritis (35.2%), rheumatoid arthritis (22.1%) and reactive arthritis (19.7%).The overall rate of sick leave at presentation was 37.7% and after 6 months 23.2%. More than one-third of the patients reported sick leave at first visit, regardless of diagnosis (Figure 1). At six months >20% sick leave was still reported in all groups except sarcoid arthritis and reactive arthritis. Smoking, low education (≤ high school), longer duration of joint swelling, ACPA and RF positivity, joint pain, fatigue, patient's global assessment, SF-36 (physical and mental component summary scores), HAQ-DI and tender joint count at baseline were univariably associated with sick leave after six months, whereas SJC, ESR and CRP were not. Independent predictors were current smoking (OR 2.1 (95% CI 1.4–3.2)), low education (OR 1.7 (95% CI 1.1–2.5)), longer duration of joint swelling and low SF-36 (physical and mental component summary scores).ConclusionsSick leave in IA is common, even six months after diagnosis. Predictors for sick leave after six months were associated with lifestyle and level of education rather than factors commonly considered to b...
BackgroundA EULAR task force has proposed that in addition to the 2010 ACR/EULAR rheumatoid arthritis (RA) classification criteria (2010 RA criteria), patients can still be classified as having RA with less than 6 criteria points on the presence of ≥3 joints with typical erosions on conventional radiographs of hands and feet (erosion criterion) (1).ObjectivesTo determine how the EULAR definition of erosive disease contributes to the number of patients classified as RA according to the 2010 RA criteria in an early arthritis cohort.MethodsPatients with arthritis of ≤16 weeks duration and a clinical diagnosis of RA or undifferentiated arthritis (UA) with available hand and feet radiographs were included from the Norwegian Very Early Arthritis Clinic (NOR-VEAC) study. Erosive disease was defined according to the EULAR definition accompanying the 2010 RA criteria, i.e. ≥3 erosive joints (1). We calculated the additional number of patients being classified as RA based on the erosion criteria at baseline and during follow-up. Other cut-offs and the distribution of erosive joints was also examined.ResultsThe current study included 289 patients (mean (SD) age 48 (14.7) years, 54.3% females, median (25, 75 perc) duration of joint swelling 46 (19.5, 79.0) days). At baseline, 120 patients (41.5%) fulfilled the 2010 RA criteria. Of the remaining 169 not fulfilling the 2010 RA criteria, 55 patients had ≥1 erosive joint (40 with hand erosions, 28 with feet erosions and 13 with hand and feet erosions) and 15 (5.2%) patients fulfilled the erosion criterion (Figure 1). The distribution of erosive joints in the 169 patients not fulfilling the 2010 RA criteria at baseline is shown in the table.Erosive joints at baseline PIPMCPWristCMC + os trapeziumMTPIP1 feet ≥1 erosive joint (n=55)23171282212≥2 erosive joints (n=27)1113108128≥3 erosive joints (n=15)689687118 patients had radiographic follow-up at 2 years, of whom only 1 additional patient solely fulfilled the erosion criterion during follow-up (7 additional patients fulfilled both the 2010 criteria and the erosion criterion). Among patients with no erosions at baseline (N=74), 13 (17.6%) developed erosions during follow-up (PIP joints n=3, MCP n=4, wrist n=3, CMC joint n=1, MTP joints n=9 and IP1 joint in the foot n=3).Figure 1ConclusionsAmong this cohort of patients with very early arthritis, 5.2% were classified as RA at baseline based solely on the erosion criterion. Of the 118 patients with 2-year follow-up data, only 1 additional patient was classified based on the erosion criterion alone during follow-up, thus, follow-up radiographs in patients with early UA do not seem to provide additional information in classifying patients with RA.References van der Heijde D, van der Helm-van Mil AH, Aletaha D, Bingham CO, Burmester GR, Dougados M, et al. EULAR definition of erosive disease in light of the 2010 ACR/EULAR rheumatoid arthritis classification criteria. Ann Rheum Dis2013 Apr;72(4):479–81. Disclosure of InterestG. Brinkmann: None declared, E. Norli: None declared, P. Bøyesen...
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