Background Oligoarthritis is as an inflammatory arthritis affecting ≤4 joints. It represents either an early clinical presentation or a unique disease phenotype within the group of the SpA. Oligoarthritis typically affects young people causing high morbidity and has a variable. We have previously reported on the effect of early intervention with intra-articular corticosteroids and sulfasalazine (SSZ) in a cohort of patients presenting with an oligoarthritis of recent onset with 80% of patients achieving clinical remission after 52 weeks. We now report on the long-term outcome of this cohort after 10 years.
Objectives To report the rate of disease persistence/clinical remission in the long-term follow up of the Leeds cohort of early oligoarthritis.
Methods Cross-sectional follow up of patients who participated in two previous interventional studies [1, 2]. Subjects were invited to either attend for a single study visit or a telephone consult. Presence/absence of any musculoskeletal symptoms and current diagnosis was recorded. Blood tests for inflammatory markers and radiographs of SIJs or any relevant joints were performed only if clinically indicated to establish a diagnosis if persistent clinical symptoms.
Results The initial cohort comprised of a total of 117 patients, of whom 5 were deceased. An invitation letter was sent out to 112 patients (95.7%). Follow up data are available from a total of 74 patients (63.3%) [mean (SD) disease duration at presentation 13.8 (1.8) months; with a disease duration of 13 (3) years at follow up] of whom 22 (29.8%) attended for a follow up visit; 28 (37.8%) were assessed via telephone consult and 24 (32.4%) had data extracted from the clinical notes. Analysis of the attenders show that 47 patients (63.5%) had had persistent arthritis since the end of the previous studies (19.5% were RF positive; 33.3% antiCCP positive and 32.4% HLA B27 positive). The majority (74%) had received joint steroid injections ± SSZ as previous study protocols. Only 17% had a monoarticular presentation. The majority of patients (83%) had an oligoarticular pattern at disease presentation which was maintained over time in 68%. Fifteen percent (15%) had developed mixed phenotype with axial and peripheral joint involvement. 36.5% of patients (4% and 17.4% RF and HLA-B27 positive respectively) had remained asymptomatic in this time with no hospital follow up. The majority of these (57.7%) had an oligoarthritic pattern at presentation (42.3% monoarthritis), 65.4% had received intra-articular steroids in the previous studies.
Conclusions Ten year follow up of an early oligoarthritis cohort shows that over a third of patients attending for review are in drug free clinical remission. The majority had received joint steroid injections ± SSZ early on in their disease onset suggesting that early intervention may lead to clinical remission. These results can throw important insights into the pathogenesis of this condition and provide useful guidance for clinicians managing these patients.
Green, M., et al. Arthritis & Rheumatism, 2001. 44(5): p. 1177-1183.
Marzo-Ortega, H., et al. Arthritis & Rheumatism, 2007. 57 (1): p. 154-160.
Disclosure of Interest None Declared