Background The early phase of rheumatoid arthritis (RA), known as “window of opportunity” was considered to be represented by the first years of evolution, but nowadays this period is considered to be very short and therapeutic intervention at this point is very important for better long-term outcomes (1).
Objectives The aim of this study is to describe the epidemiology of early RA (ERA) in a population of Romanian patients from an Early Arthritis Research Center (EARC).
Methods We have evaluated the data obtained from patients diagnosed with ERA in the EARC of “Dr. I. Cantacuzino” Hospital. Only data form patients who fulfilled EULAR/ACR 2010 criteria for RA (2) and had symptom duration less than 12 months were analyzed.
Results 217 patients were referred to the EARC between 2010 and 2015, among whom only 47 patients fulfilled the EULAR/ACR criteria for RA and had a duration of symptoms for less than 12 months. There was a clear predominance of women (61.7%). The mean age was 55.17±14.62 years and the difference wasn't statistically significant between sexes (p=0.311). 17 patients (36.2%) were smokers and they presented higher values of ACPA but the difference wasn't significant between smokers and non-smokers (p=0.466). The mean duration of symptoms was 3.48±3.32 months and 36 patients (76.59%) had a duration of symptoms less or equal to 3 months which classifies them as very ERA (VERA). Patient positives for RF and ACPA were 87.2% and 82.1%, respectively. The vast majority of patients (74.5%) presented with polyarticular involvement. 68.1% of patients administered treatment with NSAIDs, while 23.4% didn't receive any treatment and no patient was treated with DMARDs previously. Patients with no previous treatment had higher values of disease activity indices than those who had administered NSAIDs, but the difference assessed by Wilcoxon test wasn't significant (p>0.05 for all disease activity indices). The median value and interquartile range for lab tests and for disease activity indices are shown in Table 1.
The level of acute phase reactants didn't correlate with the level of RF or ACPA (p>0.05 for each Spearman correlation). CDAI and SDAI identified more patients with high disease activity than DAS28.
Conclusions There are large variations in epidemiologic parameters of different populations with early RA and knowing the particularities of the population treated is important to improve clinical practice. Although the majority of patients presented very early in the course of the disease, they had polyarticular involvement and very active disease. NSAIDs were administered by the majority of patients before the first presentation and this can lead to a decrease in disease activity parameters. This is an ongoing study and we have to see if this results are maintained on larger numbers of patients.
van Nies JAB et al. Ann Rheum Dis. 2015;74:806–812
Aletaha D et al. Arthritis Rheum. 2010;62:2569–2581
Disclosure of Interest None declared