Diagnostic spectrum and 2-year outcome in a cohort of patients with very early arthritis

Abstract

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.

Risk Factors for Developing Rheumatoid Arthritis in Patients With Undifferentiated Arthritis and Inflammatory Arthralgia

“…Although in most EACs symptom durations <1 year are an inclusion criterion, patients with gradual symptom onset had a 1.5 higher odds ratio (OR) of developing RA than those with acute or subacute symptoms ( 10 , 25 – 27 ). In studies performed with patients diagnosed with very early arthritis (i.e., disease durations < 16 weeks), symptom duration did not show any relation to progression to RA ( 24 , 28 ).…”

Characterization of patients with undifferentiated arthritis and evolution to other inflammatory diseases in a Colombian northwestern cohort: An observational study

“…Esta información es relevante en el enfoque clínico de estos sujetos y porque hace parte importante de los criterios clínicos para considerar una artralgia sospechosa de AR (22). Con respecto a las características clínicas (23,24), se evidenció que las articulaciones grandes estuvieron comprometidas con mayor frecuencia, lo que concuerda con lo publicado en estudios previos (25). El tratamiento ordenado con mayor frecuencia fueron esteroides y antirreumáticos, lo cual es congruente con lo reportado en la literatura, en la cual se ha evidenciado que el inicio temprano con fármacos antirreumáticos modificadores de la enfermedad (DMARD), asociados a esteroides como estrategia de manejo, previene el daño articular y la incapacidad funcional en pacientes con AI (26)(27)(28), lo que pudiera tener inferencia en la tasas de progresión a AR.…”

Early Undifferentiated Arthritis: A Developing Country Perspective from Nepal

“…In terms of revision of diagnosis on follow-up, a recent two year outcome study showed that the diagnosis remained as UA in 41% patients and changed to RA in 24% of patients and after two years, arthritis resolved in 59% of EUA patients. 62 An unpublished data from Nepal shows that the diagnosis remained as UA in 57% of patients and changed to RA in 34% at 6 months follow-up. Drug free remission at six months were seen in only 4 out of 443 patients completing 6 months follow-up.…”