Role of erosions typical of rheumatoid arthritis in the 2010 ACR/EULAR rheumatoid arthritis classification criteria: results from a very early arthritis cohort

Brinkmann, Gina Hetland; Norli, Ellen Sauar; Bøyesen, Pernille; Heijde, Desirée van der; Grøvle, Lars; Haugen, Anne Julsrud; Nygaard, Halvor; Bjørneboe, Olav; Thunem, Cathrine; Kvien, Tore K; Mjaavatten, Maria D; Lie, Elisabeth

doi:10.1136/annrheumdis-2017-211350

Cited by 9 publications

(6 citation statements)

References 10 publications

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“…In the last 20 years, the availability of EACs (19) has certainly allowed to significantly reduce the diagnostic delay, nevertheless a late search for medical care tends to increase this delay (20). At baseline, our population showed clini-cal characteristics in line with similar European cohorts (21,22). The median delay before starting a treatment with a DMARD in general was of 205 days, while the time between the onset of symptoms and the beginning of MTX was of 197 days.…”

Section: Discussionmentioning

confidence: 61%

Methotrexate in Italian patients wiTh Rheumatoid Arthritis (MITRA study): an observational study about the use of methotrexate in early RA patients and the adherence to the EULAR 2013 recommendations. A project of the Italian Society for Rheumatology

Benaglio

Fornaro

Montecucco

et al. 2021

Clinical and Experimental Rheumatology

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ObjectiveTo assess the delay between the disease onset and the beginning of methotrexate (MTX) treatment in RA patients and to evaluate the Italian rheumatologists' adherence to the EULAR 2013 recommendations. Methods MITRA is anItalian multicentre observational study carried out on DMARD-naïve RA patients recruited in an 18-month period starting from 2015. The data related to the patients' characteristics at baseline will be presented. Results patients from 13Italian centres were recruited: the median delay between the onset of symptoms and the beginning of ; in 20% of patients a treatment with DMARDs was started within the first 90 days from the onset of symptoms. The clinical target selected was DAS28 remission in 64.2% of cases and low disease activity in 35.8%. Among patients in DAS28 high disease activity, 92.6% received a control visit which was rescheduled within the first 3 months, similarly to those in DAS28 moderate disease activity (91.6%). A DMARD monotherapy was prescribed in 319 patients, while a combined therapy of DMARDs was preferred in 13 cases; 282 patients were treated with MTX. Glucocorticoids were prescribed in 229 patients: the median dosage was of 5 mg ) of prednisone equivalent/day. ConclusionDiagnostic delay in RA patients continues to be longer than expected. The choice of low disease activity as a target is still very frequent and tight control does not seem to be based on disease activity. This paper offers a realistic and detailed picture of the clinical practice among Italian rheumatologists.

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Section: Discussionmentioning

confidence: 61%

Methotrexate in Italian patients wiTh Rheumatoid Arthritis (MITRA study): an observational study about the use of methotrexate in early RA patients and the adherence to the EULAR 2013 recommendations. A project of the Italian Society for Rheumatology

Benaglio

Fornaro

Montecucco

et al. 2021

Clinical and Experimental Rheumatology

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“…In our study, 73% of the ACR/EULAR negative patients displayed ≥3 joints with erosions as compared with 11.7% in the Leiden cohort, 17.4% in the ESPOIR cohort 3 and 5.4% published from a Norwegian Very Early Arthritis Clinic. 16 In the SCQM cohort, patients with early arthritis were included at the discretion of the treating rheumatologist. All were then treated with DMARDs.…”

Section: Discussionmentioning

confidence: 99%

Clinical and radiographic course of early undifferentiated arthritis under treatment is not dependent on the number of joints with erosions at diagnosis: results from the Swiss prospective observational cohort

et al. 2018

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ObjectiveTo analyse whether early arthritis patients who do not fulfil the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2010 classification criteria for rheumatoid arthritis (RA) have a different course of the disease dependent on whether they can or cannot be classified as RA because of radiographic disease (EULAR task force) at diagnosis.MethodsFor this observational study within the Swiss RA cohort SCQM, we included patients with early undifferentiated arthritis (disease duration ≤1 year), who had not received any previous disease-modifying antirheumatic drugs (DMARDs). 2010 ACR/EULAR criteria negative patients were separated into two groups (radiographic vs non-radiographic arthritis) depending on whether or not they had radiographic changes defined as erosive disease by a EULAR task force (≥3 joints with erosions). The primary outcome measure was the radiographic progression detected employing the Ratingen erosion score. Health Assessment Questionnaire (HAQ) and DAS-28 were used as secondary outcome measures. The average observation period was 4 years.ResultsA total of 592 patients were analysed. 240 were not classifiable as RA by application of the 2010 ACR/EULAR criteria at baseline. In 57 patients, radiographs at the first visit were not available. 133 patients had radiographic arthritis and 50 non-radiographic arthritis. Treatment was initiated in all patients with DMARDs, mostly methotrexate. No differences in DAS-28 and HAQ scores were found during follow-up. The average erosion scores were higher among patients with initially radiographic arthritis throughout the study. The progression of erosion scores over time, however, was higher in patients with initially non-radiographic arthritis with less subsequent radiological progression (3.3 erosions/year vs 0.4, respectively, p<0.0001).ConclusionsThe clinical and radiographic course of early undifferentiated arthritis under treatment was not dependent on the presence of erosions in three or more joints (ie, the definition of radiographic disease by the EULAR task force) at diagnosis in our cohort.

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“…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.…”

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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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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Role of erosions typical of rheumatoid arthritis in the 2010 ACR/EULAR rheumatoid arthritis classification criteria: results from a very early arthritis cohort

Abstract: Few patients with early arthritis were classified as RA based on solely the erosion criteria, and of those who did almost all did so at baseline.

Cited by 9 publications

References 10 publications

Methotrexate in Italian patients wiTh Rheumatoid Arthritis (MITRA study): an observational study about the use of methotrexate in early RA patients and the adherence to the EULAR 2013 recommendations. A project of the Italian Society for Rheumatology

Methotrexate in Italian patients wiTh Rheumatoid Arthritis (MITRA study): an observational study about the use of methotrexate in early RA patients and the adherence to the EULAR 2013 recommendations. A project of the Italian Society for Rheumatology

Clinical and radiographic course of early undifferentiated arthritis under treatment is not dependent on the number of joints with erosions at diagnosis: results from the Swiss prospective observational cohort

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

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