Gina H Brinkmann1,2, Ellen S Norli3,4, Tore K Kvien3,4, Anne J Haugen3,4, Lars Grøvle3,4, Halvor Nygaard3,4, Olav Bjørneboe3,4, Cathrine Thunem3,4, Maria D Mjaavatten3,4, Elisabeth Lie3,4. 1. From the Department of Rheumatology, Østfold Hospital Trust, Grålum; Department of Rheumatology, Martina Hansens Hospital, Bærum; Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer; Department of Rheumatology, Betanien Hospital, Skien, Norway. gina_hetland@hotmail.com. 2. G.H. Brinkmann, MD, Department of Rheumatology, Østfold Hospital Trust; E.S. Norli, MD, Department of Rheumatology, Martina Hansens Hospital; T.K. Kvien, MD, PhD, professor, Department of Rheumatology, Diakonhjemmet Hospital; A.J. Haugen, MD, PhD, Department of Rheumatology, Østfold Hospital Trust; L. Grøvle, MD, PhD, Department of Rheumatology, Østfold Hospital Trust; H. Nygaard, MD, Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases; O. Bjørneboe, MD, Department of Rheumatology, Martina Hansens Hospital; C. Thunem, MD, Department of Rheumatology, Betanien Hospital; M.D. Mjaavatten, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; E. Lie, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital. gina_hetland@hotmail.com. 3. From the Department of Rheumatology, Østfold Hospital Trust, Grålum; Department of Rheumatology, Martina Hansens Hospital, Bærum; Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer; Department of Rheumatology, Betanien Hospital, Skien, Norway. 4. G.H. Brinkmann, MD, Department of Rheumatology, Østfold Hospital Trust; E.S. Norli, MD, Department of Rheumatology, Martina Hansens Hospital; T.K. Kvien, MD, PhD, professor, Department of Rheumatology, Diakonhjemmet Hospital; A.J. Haugen, MD, PhD, Department of Rheumatology, Østfold Hospital Trust; L. Grøvle, MD, PhD, Department of Rheumatology, Østfold Hospital Trust; H. Nygaard, MD, Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases; O. Bjørneboe, MD, Department of Rheumatology, Martina Hansens Hospital; C. Thunem, MD, Department of Rheumatology, Betanien Hospital; M.D. Mjaavatten, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; E. Lie, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital.
Abstract
OBJECTIVE: To examine the 2-year disease course in patients with undifferentiated arthritis (UA) focusing on fulfillment of the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) rheumatoid arthritis (RA) classification criteria. METHODS: Data were provided by the Norwegian Very Early Arthritis Clinic study, which included patients presenting with ≥ 1 swollen joint of ≤ 16 weeks' duration. UA was defined as patients not fulfilling the 2010 ACR/EULAR RA criteria and who did not have a clinical diagnosis other than RA at baseline. The main outcome was fulfillment of the 2010 RA criteria. Secondary outcomes were disease-modifying antirheumatic drug (DMARD) use, resolution of synovitis without use of DMARD during followup, and final clinical diagnosis. RESULTS: We included 477 patients with UA of whom 47 fulfilled the 2010 ACR/EULAR RA criteria during followup (UA-RA) and 430 did not (UA-non-RA). Of the UA-RA patients, 70% fulfilled the criteria within the first 6 months. UA-RA patients were older, more often positive for rheumatoid factor and anticitrullinated protein antibodies, female, and ever smokers, and they more often presented with polyarticular arthritis, small joint involvement, and a swollen shoulder joint. During followup, 53% of UA-RA patients vs 13% of UA-non-RA patients used DMARD (p < 0.001). Overall, 71% of patients with UA achieved absence of clinical synovitis at final followup without use of DMARD. The most frequent final clinical diagnosis was UA (61%). CONCLUSION: Only 9.8% of patients with UA fulfilled the 2010 RA criteria during 2-year followup. Small joint involvement and swollen shoulder joint were among the factors associated with RA development. In two-thirds of patients with UA, the arthritis resolved without use of DMARD.
OBJECTIVE: To examine the 2-year disease course in patients with undifferentiated arthritis (UA) focusing on fulfillment of the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) rheumatoid arthritis (RA) classification criteria. METHODS: Data were provided by the Norwegian Very Early Arthritis Clinic study, which included patients presenting with ≥ 1 swollen joint of ≤ 16 weeks' duration. UA was defined as patients not fulfilling the 2010 ACR/EULAR RA criteria and who did not have a clinical diagnosis other than RA at baseline. The main outcome was fulfillment of the 2010 RA criteria. Secondary outcomes were disease-modifying antirheumatic drug (DMARD) use, resolution of synovitis without use of DMARD during followup, and final clinical diagnosis. RESULTS: We included 477 patients with UA of whom 47 fulfilled the 2010 ACR/EULAR RA criteria during followup (UA-RA) and 430 did not (UA-non-RA). Of the UA-RA patients, 70% fulfilled the criteria within the first 6 months. UA-RA patients were older, more often positive for rheumatoid factor and anticitrullinated protein antibodies, female, and ever smokers, and they more often presented with polyarticular arthritis, small joint involvement, and a swollen shoulder joint. During followup, 53% of UA-RA patients vs 13% of UA-non-RA patients used DMARD (p < 0.001). Overall, 71% of patients with UA achieved absence of clinical synovitis at final followup without use of DMARD. The most frequent final clinical diagnosis was UA (61%). CONCLUSION: Only 9.8% of patients with UA fulfilled the 2010 RA criteria during 2-year followup. Small joint involvement and swollen shoulder joint were among the factors associated with RA development. In two-thirds of patients with UA, the arthritis resolved without use of DMARD.
Authors: Cleo Rogier; Myrthe van der Ven; Annette H M van der Helm-van Mil; Pascal H P de Jong Journal: Rheumatology (Oxford) Date: 2020-09-01 Impact factor: 7.580