Objectives To report the 5-year outcome of a large prospective cohort of patients with very early rheumatoid arthritis (RA), and to identify predictive factors of outcome.
Methods Patients were recruited if they had early arthritis of less than 6 months’ duration, a high probability of developing RA, and had never been prescribed DMARDs or steroids. Patients were followed every 6 months during the first 2 years, then every year. Logistic regression analysis was used to determine predictive factors of outcome.
Results 813 patients were included from December 2012 to april 2005: age was 48.1 ± 12.6 years, delay before referral 103.1 ± 52.4 days, DAS28 5.1 ± 1.3, HAQ 1.0 ± 0.7; 44.2 and 38.8% had IgM Rheumatoid Factor or anti-CCP2 antibodies; 22% had hands or feet erosions; 78.5% fulfilled the ACR/EULAR criteria for RA at baseline and 93.8% during follow-up. 573 patients were evaluated at 5 years. The outcome was mild for most patients: disease activity (median DAS28 2.5) and HAQ (median 0.3) were well controlled over time; 47.6% achieved DAS28 remission and 64.6% low disease activity in the first 2 years. Radiographic progression was low (2.9 Sharp unit / year). Only a few patients required joint surgery, but some developed new co-morbidities (eg, hyperlipemia, cardiovascular diseases). During the 5 years, 82.7% of patients had received at least one DMARD (methotrexate: 65.9%) usually as monotherapy, 18.3% a biological DMARD, and about 60% prednisone at least once (mean dosage 8.8 ± 7.7 mg/day). Anti-CCP2 antibodies was the best predictor of 5-year remaining in the cohort, prescription of synthetic or biologic DMARDs, and radiographic progression.
Conclusions The generally good 5-year outcome of this cohort could be related to early referral, early effective treatment and close monitoring which are key processes in the management of early RA in daily practice.
Disclosure of Interest B. Combe: None Declared, N. Rincheval: None Declared, J. Benessiano: None Declared, F. Berenbaum: None Declared, A. Cantagrel: None Declared, J.-P. Daures: None Declared, M. Dougados: None Declared, P. Fardellone: None Declared, B. Fautrel: None Declared, R.-M. Flipo: None Declared, P. Goupille: None Declared, F. Guillemin: None Declared, X. Le Loet: None Declared, I. Logeart Employee of: Pfizer, X. Mariette: None Declared, O. Meyer: None Declared, P. Ravaud: None Declared, A. Saraux: None Declared, T. Schaeverbeke: None Declared, J. Sibilia: None Declared