Disease activity and joint damage progression in early rheumatoid arthritis: relation to IgG, IgA, and IgM rheumatoid factor.

Abstract

The clinical and biochemical correlations with joint damage progression over two years in a consecutive group of 68 patients with rheumatoid arthritis with disease duration of less than two years are reported. Joint damage was assessed with Larsen's severity scale and a measure of change in progression rate constructed. Initial haemoglobin concentration, Ritchie index, and Waaler-Rose titre in combination accounted for one third of the variance in joint damage progression. Rheumatoid factor (RF) Patients and methodsSeventy one patients-from primary care units in the area with definite rheumatoid arthritis2 and disease duration of less than two years were enrolled in the study. During a follow up of 24 months two patients died owing to pulmonary carcinoma, and another patient was reclassified as psoriatic arthritis. The remaining 68 patients (26 men, 42 women) had a mean (SD) age of 56 1 (14-1) years and mean (SD) disease duration at the start of the study of 11-8 (6 8) months.During the study period about half of the patients were treated with slow acting antirheumatic drugs, mostly antimalarial drugs (20 patients) or D-penicillamine (10 patients). CLINICAL EVALUATIONThe patients were evaluated at regular intervals by clinical and laboratory measures as previously described.' Briefly, the articular disease was estimated by the Ritchie index3 and an active joint count.4 Grip strength was measured with a sphygmomanometer (mean of readings for right and left hand). Functional capacity was assessed with a validated Swedish version of the Stanford Health Assessment Questionnaire disability index.5 6 Pain during the preceding week was recorded on a visual analogue scale. RADIOLOGICAL EVALUATIONRadiographic examinations of hands, wrists, and feet were performed at study start and after 12 and 24 months. All radiographs were evaluated by one experienced radiologist and the findings were scored using the method described by Larsen.7 Thus each joint was compared with standard reference films and assigned a score between 0 (normal) and 5 (mutilating changes). Severity stage 1 corresponded to non-erosive changes-that is, soft tissue swelling and periarticular osteoporosis, and stages 2-4 corresponded to increasing degrees of erosions and joint space narrowing. Thirty two joints were evaluated: the wrists, the metacarpophalangeal joints I-V, interphalangeal joint I, proximal interphalangeal joints II-V of the hands and the interphalangeal joint I and metatarsophalangeal joints II-V of the feet. The wrist score was multiplied by five and all the scores added up, together forming the joint damage index. In addition, a modified index omitting severity stage 1 was calculated.In analyses of radiological outcome the absolute difference between scores after two years and at study start was taken into account. A new radiological measure assessing the change in progression rate between the first and second 12 month period was constructed according to the formula illustrated in the figure. The usefulness of the new index wa...

The relationship between disease activity and radiologic progression in patients with rheumatoid arthritis: A longitudinal analysis

“…It is generally accepted that rheumatoid factorpositive patients have worse outcomes with respect to radiologic progression, disease activity, and functional ability (24,25). Our results suggest that the presence of rheumatoid factor determines whether fluctuations in joint inflammation lead to important radiologic damage.…”

Outcome in patients with early rheumatoid arthritis treated according to the “sawtooth” strategy

“…Our results at the 2-year followup are comparable with those of Eberhardt et a1 (33)(34)(35)(36), in which 89-113 Swedish patients with early RA were enrolled and followed up using the same methods as in our study, and actually simultaneously with the time of enrollment in our study. The proportions of patients with R F seropositivity, erosive disease, and HLA-DR4 and the degree of disease activity (Mallya score) at entry were similar in the 2 studies, while the median values of the Larsen index and MHAQ score at enrollment were higher in the Swedish study than in ours.…”

“…We considered the studies by Eberhardt et a1 (33)(34)(35)(36), performed in Sweden, to be most compatible with ours because the patients were enrolled simultaneously and disease activity and outcome were assessed by the same methods. Baseline demographic and clinical characteristics of the patients in the present study and the Swedish cohort are described in Table 7.…”

“…We found in the English-language literature 5 prospectively studied cohorts that included 50 or more consecutive clinic patients who had early RA at enrollment and were followed up for 2 years or more (24,25,(32)(33)(34)(35)(36)(37)(38). Male/female distribution, mean disease duration, frequency of RF seropositivity, and frequency of DR4 among the patients in these cohorts were similar, but the proportion of patients treated with SAARDs during the studies varied (Table 6).…”

Prognostic laboratory markers of joint damage in rheumatoid arthritis

“…We have earlier reported that IgG RF showed the strongest relation to joint damage after two years of follow up in this cohort. 47 The discrepant findings might be explained by the shorter follow up period, different assessment methods, and fewer patients.…”