Background Rheumatoid arthritis (RA) is known to have a variable course resulting in a wide range of outcomes, varying from a mild disease causing hardly any impairment to severe disease leading to extensive disability and radiological damage1,2.
Objectives The aim of the present study was to identify predictive factors for unfavorable outcomes in early rheumatoid arthritis patients.
Methods The 1-year outcome of RA patients from a prospective inception cohort (CONAART-Argentine Consortium for Early Arthritis) was assessed. We defined the following 3 criteria for unfavorable outcomes: a clinical course with persistent moderate-high disease activity during the last 6 months (DAS28 average ≥ 3.2, or an increase > 1.2 compared to baseline, or at least one DAS28 >5.1), a disability worsening and a radiological damage increasing (HAQ deterioration within 1 year of ≥ 0.5 points and Simple Erosion Narrowing Score (SENS)- deterioration within 1 year of ≥ 1 points, respectively). Two groups of patients (unfavorable outcome or not unfavorable outcome), were identified for each of the 3 outcome dimensions. Significance of the difference between groups was tested using a Student’s t-test, a Mann–Whitney U test, or a chi-square test where appropriate. All baseline parameters (demographic and socioeconomic parameters; comorbidities; disease characteristics; laboratory measures and radiographic measures) for both patient groups were analyzed. To calculate which baseline parameters predict outcome several logistic regression models were constructed.
Results A total of 237 patients were included; 200 (84.4%) were women; 73% rheumatoid factor positive and 71% APCA positive. The mean age was 49 years (SD 12) and the median symptoms duration was 7 months (RIQ 3-12). After one year of follow-up, 141 (59.5%) patients had persistent moderate-high disease activity, 19 (8%) HAQ deterioration and 57 (24.1%) SENS worsening.
The prognostic factors for persistent moderate-high disease activity were: medical history of anxiety or depression (OR 3.7; p 0.016), female gender (OR 3.1; p 0.003), and DAS28 (OR 1.3 p 0.005). Among all the factors we found that patients with monoarthritis at baseline had more probability of HAQ deterioration (OR 8.2; p 0.03) and greater values of DAS28 reduced it (OR 0.6 p 0.007). There were not baseline variables associated with radiographic progression.
Conclusions Our study showed that in short-term follow up of early RA patients, different outcomes could be predicted using widely available baseline parameters.
Arthritis Rheum. 2002;47:383-90.
Arthritis Res Ther. 2008;10:R106.
Disclosure of Interest L. Casalla Grant/research support from: Pfizer Argentina, R. Chaparro del Moral : None Declared, O. Rillo : None Declared, M. Benegas: None Declared, F. Dal Pra: None Declared, H. Maldonado Ficco: None Declared, G. Citera: None Declared, A. Catalan Pellet: None Declared, A. Berman: None Declared, M. Haye Salina: None Declared, A. Alvarez: None Declared, F. Caeiro: None Declared, J. Marcos: None Declared, J. C. Marcos: None Declared, L. Catoggio: None Declared, E. Soriano: None Declared, F. Ceccato: None Declared, S. Paira: None Declared, M. O. Leal: None Declared, A. Quinteros: None Declared, G. Salvatierra: None Declared, M. Crespo: None Declared