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Abstract Number: 203

Clinical Course Factors Associated with Outcome of Monoarthritis : A Retrospective Study of 173 Cases

Hyemin Jeong1, Eun-Jung Park1, Jiwon Hwang1, Ji Young Chai2, Joong Kyong Ahn3, Eun-Mi Koh4 and Hoon-Suk Cha1, 1Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, 2Division of Rheumatology, Jesang Hospital, Seongnam-si Gyeonggi-do, South Korea, 3Department of Medicine, Kangbuk Samsung hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea, 4Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Seoul, South Korea

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Behcet's syndrome, prognostic factors, rheumatoid arthritis (RA) and spondylarthropathy

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Session Information

Title: Miscellaneous Rheumatic and Inflammatory Diseases: Periodic Fever Syndromes

Session Type: Abstract Submissions (ACR)

Background/Purpose:

To evaluate the clinical features and outcomes in patients with monoarthritis and to investigate predictive factors associated with the clinical course in terms of a definite diagnosis and polyarticular involvement.

Methods:

A retrospective analysis of 173 patients who had undiagnosed monoarthritis (UMA) at least six weeks’ duration at a single tertiary hospital between January 2001 and January 2011. Baseline characteristics, laboratory data, radiographic findings and clinical course were reviewed.

Results:

Of 173 patients (80 males and 93 females), the mean age was 43.1 ± 15.1 years. The median follow-up duration was 21 months (range, 1.5 to 120). Most commonly involved joints were the knee (23.7%) and wrist (23.7%), followed by the ankle (18.5%). A definite diagnosis was made in 71 patients (40.5%); 27 patients with rheumatoid arthritis (RA) based on the 2010 ACR/EULAR classification criteria, 18 patients with Behcet`s disease (BD) according to the diagnostic criteria of the BD research committee of Japan, 23 patients with peripheral arthritis of spondyloarthropathy (SpA) based on the ASAS criteria, 2 patients confirmed with infectious arthritis (one with Nontuberculous mycobacterium and one with methicilline-resistant Staphylococcus aureus), and one patient as SAPHO syndrome. The other 102 patients (59.5%) remained unclassified because of lacking in requirements and seemed to have shorter follow-up duration (23.0 versus (vs) 16.5 months, p = 0.08). Of total 173 patients, 24 patients (13.9%) were progressed to oligo- or polyarthritis and 92 patients (53.2%) remained UMA. The rate of patients treated with non-steroidal anti-inflammatory drugs without disease modifying antirheumatic drugs is higher in UMA group than diagnosed group (53.3% vs 22.2%, p < 0.001). The UMA patients were related to lower baseline C- reactive protein (CRP) (OR 0.67, 95% CI 0.53 to 0.85, p = 0.001), and the negativity of anti-cyclic citrullinated protein antibody (ACPA) (OR 0.34, 95% CI 0.13 to 0.89, p = 0.027). Rheumatoid factor did not show significant association (OR 0.75, 95% CI 0.37 to 1.51, p = 0.418). HLA-B27 was checked in 27 patients only who were suspicious of SpA and the positivity was 44.4%. The initial site of joint involvement was predictive for later diagnosis; the wrist joint for RA (odds ratio (OR) 9.09, 95% confidence interval (CI) 3.70 to 22.34, p < 0.001), the knee joint for BD (OR 3.43, 95% CI 1.29 to 9.15, p = 0.01) and the ankle joint for peripheral SpA (OR 6.19, 95% CI 2.38 to 16.08, p < 0.001). The presence of bony erosion at initial visit was associated with the progression to oligo-or polyarthritis (OR 2.88, 95% CI 1.09 to 7.59, p=0.03).

Conclusion:

Our data showed clinical course of monoarthritis. A definite diagnosis was made in less than half of the patients and remaining UMA patients seemed to have favorable prognosis. Initial site of joint involvement, the bony erosion on initial radiograph, baseline CRP and the ACPA status can help to predict the course of monoarthritis.


Disclosure:

H. Jeong,
None;

E. J. Park,
None;

J. Hwang,
None;

J. Y. Chai,
None;

J. K. Ahn,
None;

E. M. Koh,
None;

H. S. Cha,
None.

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