Prospective evaluation of clinical profile and treatment outcome of patients presenting with polyarthritis diagnosed as rheumatoid arthritis

Abstract

Introducti on: Polyarthriti s is a common presentati on of pati ents att ending medicine outpati ent department. Among various causes Rheumatoid arthriti s is the commonest and a well established case has disti nct characteristi c features. However the early presentati on of this disease has not been clear thus leading to delay in treatment. The objecti ves of this study was to identi fy the various causes of polyarthriti s in our clinical practi ce, discuss the varied clinical presentati on of rheumatoid arthriti s including early Rheumatoid arthriti s and to evaluate the treatment response during one year follow up. Methods: Prospecti ve longitudinal study conducted in a teaching hospital over a two years periodResults: Rheumatoid arthriti s was the commonest cause of polyarthriti s (77.8%) with a period prevalence of 0.7%. Early presentati on included atypical features like asymmetry, unilateral presentati on, manifesti ng within 2 months to 2 years of diagnosis. 43% (n=18) of the pati ents had swelling and tenderness in overused joints 1.5 years prior to full clinical manifestati on. Flitti ng or migratory joint pain not considered to be a feature of rheumatoid arthriti s was also present in 14.3% (n=6) pati ents with mean durati on of 1.5 years prior to full blown presentati on. MCPJ (metacarpophalyngeal joints) and PIP (proximal interphalyngeal joints) were involved in 90%. Treatment response with Methotrexate as a single DMARD was good as compared with DAS 28 ESR score. Conclusions:RA is a common arthriti s with varied clinical presentati on. Recogniti on of early symptoms is needed for early diagnosis and initi ati on of DMARD. Methotrexate as a DMARD is eff ecti ve and should be initi ated early.