Rheumatoid Arthritis in Recession

Alcorn, Nicola; Chee, Meng May; Murdoch, Robert; Madhok, Rajan

doi:10.3899/jrheum.090571

Cited by 3 publications

(2 citation statements)

References 13 publications

(6 reference statements)

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“…7 It has been suggested that RA is evolving into a milder disease at presentation in the last decades, which is probably partly because of patients presenting themselves earlier in the disease course. 8,9 This trend would decrease the prevalence of erosions at diagnosis and limit diagnostic and/or prognostic value of routine X-HF. 10,11 A more recently published letter reported prevalence of erosions of only 1.8% in a cohort of 710 patients.…”

Section: Introductionmentioning

confidence: 99%

“…Of the remaining 169 patients not fulfilling the 2010 ACR/EULAR criteria, 55 patients had one or more erosive joints, and 15 patients had three or more erosive joints 7 . It has been suggested that RA is evolving into a milder disease at presentation in the last decades, which is probably partly because of patients presenting themselves earlier in the disease course 8,9 . This trend would decrease the prevalence of erosions at diagnosis and limit diagnostic and/or prognostic value of routine X‐HF 10,11 .…”

Section: Introductionmentioning

confidence: 99%

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Limited Diagnostic and Prognostic Value of Routine Radiographs in Newly Presenting Arthritis Suspected of Rheumatoid Arthritis: A Retrospective Study

Ulijn,

den Broeder,

Ten Cate

et al. 2024

Arthritis Care & Research

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ObjectiveCurrent recommendations suggest that patients with newly presenting arthritis suspected of Rheumatoid Arthritis (RA) should undergo routine radiographs of hands and feet (X‐HF) as the presence of RA‐associated erosions might be of diagnostic and prognostic value. Our objective was investigate the prevalence, diagnostic and prognostic value of RA‐associated erosions seen on routine X‐HF in a large, recent cohort of newly presenting arthritis patients.MethodsA retrospective cohort study was performed between 2016‐2019 in patients with newly presenting arthritis suspected of RA. Patients were included if arthritis was present at diagnosis, Rheumatoid Factor and Anti‐Citrullinated Protein Antibodies were measured, RA was noted in the differential diagnosis, and routine X‐HF were conducted. Outcomes were the prevalence of ≥1 RA‐associated erosion, and whether diagnostic or prognostic classification were changed by erosivity. Seronegative patients, patients without Acute Phase Reactants (APR) and patients with longer symptom duration were analyzed as subgroups.ResultsRA‐associated erosions were found in 32/724 patients (4.4%, CI 3.1‐6.2%). Erosions led to a change of diagnostic classification in two patients (0.3%, 95%CI 0.01‐1.1%) and changed prognostic classification in three patients (0.4%, 95%CI 0.1‐1.3%). Seronegative patients and patients without elevated APR had significantly lower prevalence of erosions (χ2 9.4, P=0.002, χ2 6.5, P=0.01). Longer symptom duration was not associated with a different prevalence of erosions (χ2 0.4, P=0.81).ConclusionThe recommendation of conducting routine X‐HF in patients with newly presenting arthritis suspected of RA might be reconsidered, due to low prevalence of early erosive disease and lack of diagnostic and prognostic value.image

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Limited Diagnostic and Prognostic Value of Routine Radiographs in Newly Presenting Arthritis Suspected of Rheumatoid Arthritis: A Retrospective Study

Ulijn,

den Broeder,

Ten Cate

et al. 2024

Arthritis Care & Research

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Rheumatoid arthritis

2010

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Rheumatoid arthritis is characterised by persistent synovitis, systemic inflammation, and autoantibodies (particularly to rheumatoid factor and citrullinated peptide). 50% of the risk for development of rheumatoid arthritis is attributable to genetic factors. Smoking is the main environmental risk. In industrialised countries, rheumatoid arthritis affects 0·5-1·0% of adults, with 5-50 per 100 000 new cases annually. The disorder is most typical in women and elderly people. Uncontrolled active rheumatoid arthritis causes joint damage, disability, decreased quality of life, and cardiovascular and other comorbidities. Disease-modifying antirheumatic drugs (DMARDs), the key therapeutic agents, reduce synovitis and systemic inflammation and improve function. The leading DMARD is methotrexate, which can be combined with other drugs of this type. Biological agents are used when arthritis is uncontrolled or toxic effects arise with DMARDs. Tumour necrosis factor inhibitors were the first biological agents, followed by abatacept, rituximab, and tocilizumab. Infections and high costs restrict prescription of biological agents. Long-term remission induced by intensive, short-term treatment selected by biomarker profiles is the ultimate goal.

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