Identifying Arthralgia Patients At Risk for Rheumatoid Arthritis in the Rotterdam Early Arthritis Cohort

M. van der Veer¹, D. van Zeben², A.E.A.M. Weel³, P.J. Barendregt³, A.H. Gerards⁴, Johanna M.W. Hazes⁵ and Jolanda J. Luime⁵, ¹Department of Rheumatology, ErasmusMC, Rotterdam, Netherlands, ²Department of Rheumatology, Sint Franciscus Gasthuis, Rotterdam, Netherlands, ³Department of Rheumatology, Maasstad Hospital, Rotterdam, Netherlands, ⁴Department of Rheumatology, Vlietland Hospital, Schiedam, Netherlands, ⁵Rheumatology, Erasmus University Medical Center, Rotterdam, Netherlands

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Inflammatory arthritis and rheumatoid arthritis (RA)

Session Information

Title: Rheumatoid Arthritis - Clinical Aspects III: Infections/Risk Factors for Incident Rheumatoid Arthritis/Metrology/Classification/Biomarkers/Predictors of Rheumatolid Arthritis Activity & Severity

Session Type: Abstract Submissions (ACR)

Background/Purpose:

Patients with rheumatoid arthritis (RA) frequently have a high disease burden and erosions at first presentation because of the insidious nature of the disease. Previous studies showed that early recognition and initiation of therapy lowers the risk for developing erosive disease and leads to a better quality of life. Our aim is to identify predictive features in patients at risk for rheumatoid arthritis when inflammatory joint complaints are present but before synovitis is observed.

Methods:

We used data from the Rotterdam Early Arthritis Cohort (REACH). Patients with two or more joints with pain or loss of movement with two or more of the following criteria: morning stiffness for more than 1 hour; unable to clench a fist in the morning; pain when shaking someone’s hand; pins and needles in the fingers; difficulties wearing rings or shoes; a family history of RA; unexplained fatigue for less than 1 year were eligible. All patients did not have synovitis at baseline. Data were analyzed using simple descriptive analysis and univariate logistic regression in STATA12.

Results:

458 patients fulfilled the REACH criteria without synovitis at baseline. After 12 months 40 patients developed arthritis (8.7%), 34 out of those 40 developed arthritis within the first six months (85%). Rheumatoid arthritis was diagnosed 16 times in the arthritis group (40%). A predictor for developing arthritis was positive ACPA (OR 10.5, 95% CI 4.5-24.5). In the 28 ACPA positive patients at baseline, 12 patients developed arthritis (43%), after 12 months 16 patients were still free from arthritis. Increasing ESR was the second predictive feature (OR 1.06 per point ESR, 95% CI 1.03-1.09). RF was a less strong predictor (OR 2.86, 95% CI 1.08-7.52). No difference was observed for age, gender, tender joint count, symmetry of joint complaints, distribution of joints in a rheumatoid arthritis pattern, smoking, education level, VAS and CRP.

Conclusion:

In patients with inflammatory joint complaints, raised ESR and positive ACPA both predicted the development of arthritis within 12 months. Therefore, we advise to monitor patients with inflammatory joint complaints with positive ACPA or/and raised ESR carefully.

Disclosure:

M. van der Veer,
None;

D. van Zeben,
None;

A. E. A. M. Weel,
None;

P. J. Barendregt,
None;

A. H. Gerards,
None;

J. M. W. Hazes,
None;

J. J. Luime,
None.

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