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Only 9.8% of patients with UA fulfilled the 2010 RA criteria during 2-year followup. Small joint involvement and swollen shoulder joint were among the factors associated with RA development. In two-thirds of patients with UA, the arthritis resolved without use of DMARD.

ObjectiveThe objective of this study was to compare achievement of remission in 2 early rheumatoid arthritis (RA) treat‐to‐target (TTT) cohorts, a tight control cohort with a target of stringent remission in a randomized controlled trial and an observational cohort targeting a looser definition of remission in clinical practice.MethodsWe analyzed data from the Aiming for Remission in Rheumatoid Arthritis: a randomised trial examining the benefit of ultrasound in a Clinical Tight Control regimen (ARCTIC) trial and the Norwegian Very Early Arthritis Clinic (NOR‐VEAC) observational study. Both were Norwegian multicenter studies that included disease‐modifying antirheumatic drug (DMARD)–naive RA patients and implemented TTT. The target in the ARCTIC trial was remission defined as a Disease Activity Score (DAS) of <1.6 plus 0 swollen joints on a 44‐joint count, while the target in the NOR‐VEAC study was the less stringent remission target of a DAS28 of <2.6. We assessed achievement of the study‐specific targets and compared the odds of achieving the American College of Rheumatology(ACR)/European League Against Rheumatism (EULAR) Boolean remission during 2 years of follow‐up.ResultsWe included 189 patients from the ARCTIC trial and 330 patients from the NOR‐VEAC study. The study‐specific target had been achieved in more than half of the patients in each cohort at 6 months, increasing to >60% at 12 and 24 months. The odds of achieving ACR/EULAR Boolean remission during follow‐up were higher in the ARCTIC trial than in the NOR‐VEAC study, with significant differences at 3 months (odds ratio 1.73 [95% confidence interval 1.03–2.89]), 12 months (odds ratio 1.97 [95% confidence interval 1.21–3.20]), and 24 months (odds ratio 1.82 [95% confidence interval 1.05–3.16]).ConclusionA majority of patients in both cohorts reached the study‐specific treatment targets. More patients in the ARCTIC trial than in the NOR‐VEAC study achieved ACR/EULAR Boolean remission during follow‐up, suggesting that targeting a more stringent definition of remission provides further potential for favorable outcomes of a TTT strategy.

ObjectivesTo describe the diagnostic spectrum, arthritis persistency and clinical outcomes after 2 years in patients with inflammatory arthritis (IA) of less than 16 weeks’ duration.MethodsData from the Norwegian Very Early Arthritis Clinic, a 2-year 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. In all patients who had any follow-up information (population A), clinical diagnoses and persistency of arthritis were described. For patients with 2-year follow-up (population B), we also studied other clinical outcomes (disease activity, pain, fatigue, functional disability and health-related quality of life).ResultsIn population A (n=1017) median (25th–75th percentile) duration of joint swelling was 35.0 (13.0–66.5) days, mean (SD) age 45.7 (14.8) years, 55.2% were females and 17.8% anticitrullinated protein antibodies positive. The most common final diagnoses were undifferentiated arthritis (UA) (41.7%), rheumatoid arthritis (RA) (24.1%) and reactive arthritis (18.1%). After 2 years, the arthritis had resolved in 59% of the patients. The remaining 41.0% had persistent disease defined by disease modifying antirheumatic drug (DMARD) use (32.1%) or persistent joint swelling without DMARD use (8.9%). In population B (n=669), all clinical outcomes improved significantly (P<0.001). Baseline joint pain and fatigue were similar across diagnoses.ConclusionsAmong 1017 patients with IA of ≤16 weeks’ duration, UA was the most common diagnosis after 2 years, and less than one-fourth were diagnosed with RA. Arthritis resolved without DMARDs in the majority of the patients. All clinical parameters improved significantly over a 2-year course.

Few patients with early arthritis were classified as RA based on solely the erosion criteria, and of those who did almost all did so at baseline.

No abstract

Approximately one-fourth of patients with recent-onset monoarthritis developed CIRD over 2 years. Patients presenting with ankle arthritis rarely developed CIRD, whereas patients presenting with wrist arthritis more frequently did so. Longer duration of joint swelling and ACPA- and RF positivity were also predictive of CIRD. Our findings facilitate early identification of monoarthritis patients with unfavorable prognosis. This article is protected by copyright. All rights reserved.

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...