Has the Severity of Rheumatoid Arthritis at Presentation Diminished Over Time?

Diffin, Janet; Marshall, Tarnya; Chipping, Jacqueline; Symmons, Deborah; Verstappen, Suzanne M M

doi:10.3899/jrheum.131136

Cited by 31 publications

(24 citation statements)

References 29 publications

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“…Swollen joints over time Tender joints over time studied periods, which is in line with a recent report of early RA [16].…”

Section: Das28 Over 5 Years Esr Over Timesupporting

confidence: 90%

Comparing Five Year Out-Come in Two Cohorts of Patients with Early Rheumatoid Arthritis – A BARFOT Study

Andersson¹,

Forslind²,

Hafström³

2015

TORJ

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Abstract:The objective of the study was to compare disease characteristics over the first 5 years of disease in patients with RA, with disease onset in 1990s and 2000s, respectively.Methods: All 2235 patients with early RA (disease duration ≤12 months) were recruited from the BARFOT prospective observational study. These patients were divided into group 1 included 1992 to 1999 (N=1084, 66% women) and group 2 included 2000 to 2006 (N=1151, 69% women). Disease Activity Score (DAS28), VAS pain and Health Assessment Questionnaire (HAQ) were assessed during 5 years. Remission was defined as DAS28 <2.6.Results: At inclusion, both women and men in group 2 had higher mean DAS28 (SD) than group 1, 5.42 (1.22) vs 5.26 (1.19), p=0.004 and 5.28 (1.22) vs 5.00 (1.27), p=0.004, respectively, mainly dependant on pain and not on inflammatory related measures. Over time DAS28 decreased and was in both genders, from 6 months to the 5-year follow-up, significantly lower in group 2. At 5-year, both women and men in group 2 had higher rate of remission than women and men in group 1. However, despite reduction of VAS pain and HAQ there were no differences in pain and HAQ between groups at any time point. Conclusion:Patients included in the 2000s achieved higher frequency of remission at the 5 year follow-up compared with those included in the 1990s, suggested to reflect the more active medical treatment. Interestingly, however, improvement in pain and HAQ did not differ between the two patient cohorts.

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“…Swollen joints over time Tender joints over time studied periods, which is in line with a recent report of early RA [16].…”

Section: Das28 Over 5 Years Esr Over Timesupporting

confidence: 90%

Comparing Five Year Out-Come in Two Cohorts of Patients with Early Rheumatoid Arthritis – A BARFOT Study

Andersson¹,

Forslind²,

Hafström³

2015

TORJ

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“…The need to better understand patterns of disease expression in rheumatoid arthritis (RA) and also wider patient characteristics is well recognized in modern day rheumatology practice and stratified medicine. Several studies report a decreasing severity of RA over time, though some controversy remains . Reports on long‐term outcomes of disease attribute the reduction in RA severity mainly to the use of earlier and more intensive disease‐modifying treatments .…”

Section: Introductionmentioning

confidence: 99%

Secular Changes in Clinical Features at Presentation of Rheumatoid Arthritis: Increase in Comorbidity But Improved Inflammatory States

Nikiphorou

Norton

Carpenter

et al. 2016

Arthritis Care & Research

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Objective: To examine secular trends in demographic, clinical manifestations and comorbidity on first presentation of RA prior to DMARD treatment.Methods: 2701 patients were recruited over 25years to two UK-based RA inception cohorts:the Early RA Study (9 centres; 1986-2001) and the Early RA Network (23 centres; 2002-2012). Trends in demographic and baseline clinical/laboratory and radiographic variables and comorbidities were estimated using mixed effects models, including random effects for recruitment centre.Results: Age-at-onset increased from 53.2 to 57.7 years in 1990 and 2010 respectively (2.6 months/year; 95% CI 1.2-4.1). Gender-ratio, the proportion living in deprived areas and smoking status were unchanged (p>0.05) and there were no changes in the proportion seropositive or erosive at baseline (p>0.05). After controlling for treatment at the time of assessment, ESR reduced and haemoglobin increased over time (p<0.05), however HAQ, DAS, DAS28, and joint counts were unchanged (p>0.05). The overall prevalence of comorbidity increased from 29.0% in 1990 to 50.7% in 2010, mainly due to cardiovascular and non-cardiac vascular conditions including hypertension. There was a significant increase in BMI (0.15 units/year; 95% CI 0.11-0.18), resulting in an increase in the prevalence of obesity from 13.3% in 1990 to 33.6% in 2010.Conclusions: Age-at-onset and comorbidity burden, especially obesity have increased at RA presentation over 25 years, reflecting wider demographic trends at the population level. In contrast there were no accompanying changes in disease severity assessed by composite markers of disease activity, radiographic erosions, seropositivity or HAQ at presentation.Treatment strategies in early RA should take greater account of the impact of co-morbidity on outcomes.

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“…Furthermore, time from symptom onset to inclusion was shorter 2011-2014. <0,001 TJC (0-28) 8,0 (6,6) 8,0 (6,1) 7,1 (6,0) 0,005 SJC (0-28) 9,5 (5,9) 9,0 (5,8) 7,6 (5,5) <0,001 HAQ (0-3) 1,1 (0,6) 1,1 (0,6) 1,0 (0,6) 0,028 EGA(VAS 0-100) 50, 3 In Swedish patients with early RA, baseline joint counts and inflammatory markers improved over the last three decades. This could partly be explained by shorter symptom duration at diagnosis but also suggests that, at onset, RA might be an inherently milder disease today.…”

Section: Discussionmentioning

confidence: 99%

Thu0072 ultrasound Predicts Imminent Progression to Arthritis in Anti-CCP Positive at-Risk Individuals

Duquenne

Mankia

Nam

et al. 2019

Poster Presentations

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BackgroundUltrasound (US) Power Doppler (PD) signal is predictive for the development of inflammatory arthritis (IA) in anti-cyclic citrullinated protein antibodies positive (CCP+) individuals with musculoskeletal (MSK) symptoms but no clinical synovitis (CS) [1]. Our previous data showed a late increase in the overall US inflammation before arthritis development, suggesting that a sub-clinical phase of synovitis could be detected [2]. This abstract describes the prediction of PD abnormalities in the months following US scan.Objectives1. Presence of PD in one joint is predictive of imminent progression to IA in the next 3months.2. A rise in the number of joints with presence of PD increases the odds of progression to IA.MethodsIn a single-centre prospective observational cohort between June 2008 and December 2018, 307 CCP+ patients with a new MSK symptom but no synovitis were followed until CS occurred. Clinical and US findings were analysed. Following our previous study, we compared progression in the 3, 12 or >12 months after a US scan. 38 joints were included in the analysis (MTPs, hands, wrists, elbows, ankles and knees). Patients with palindromic rheumatism were excluded.ResultsData from 96 CCP+ at-risk patients who developed CS (progressors) are compared to 211 CCP+ patients who did not (non-progressors). Age and gender are similar, the mean follow-up of the non-progressors is higher, with significantly more smokers and high titre CCP in the progressors group (Table1).Overall, progressors have more joints with PD than non-progressors (Figure1). Patients with PD in one joint are more likely to develop CS in the following 3 months compared to those without PD (OR 7.52) and this remain significant when only the hands and wrists are included (Table2). The highest OR is shown when PD≥2 is found in at least one wrist. Similarly, there is a significant but smaller prediction of progression between 3 to 12 months after US (Table2).When a new joint develops PD, the likelihood of progression to IA within the next 3 months increases (Table2). This is especially predictive with wrists involvement (OR 3.10). Prediction of progression between 3 to 12 months before CS is significantly different between groups, with a higher OR for the wrists.ConclusionThe presence of PD in one joint and every new joint with PD are both predictive of progression to IA within the next 3months. These results should lead to a logical programme for therapy and follow -up.Abstract THU0072– Figure 1References[1] Nam J. et al., US findings predict progression to inflammatory arthritis in anti-CCP positive patients without CS. Ann Rheum Dis, 2016. 75(12).[2] Pentony P, et al., Sequential US shows a late increase in inflammatory burden in anti-ccp positive patients with non-specific MSK symptoms just before progression to IA. Ann Rheum Dis, volume 77, year 2018Table 1 demographicsProgressorsNon-progressorsp-valueN96211Age*53.4 (13)49.8 (13.2)0.494CCP titre: High/Low(%)92.7/7.350.2/48.80.000Gender F/M(%)74/2674.9/25.10.863Weeks follow-up*76.44 (93.5)...

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Has the Severity of Rheumatoid Arthritis at Presentation Diminished Over Time?

Cited by 31 publications

References 29 publications

Comparing Five Year Out-Come in Two Cohorts of Patients with Early Rheumatoid Arthritis – A BARFOT Study

Comparing Five Year Out-Come in Two Cohorts of Patients with Early Rheumatoid Arthritis – A BARFOT Study

Secular Changes in Clinical Features at Presentation of Rheumatoid Arthritis: Increase in Comorbidity But Improved Inflammatory States

Thu0072 ultrasound Predicts Imminent Progression to Arthritis in Anti-CCP Positive at-Risk Individuals

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