Background Real life experience of early arthritis; remission or evolving to rheumatoid arthritis
Objectives To assess long term outcome, drug free remission rates of patients with early arthritis and classification based on 1987 ACR1 or 2010 ACR/EULAR2 rheumatoid arthritis (RA) criteria.
Methods Patients with arthritis with symptom duration within the first 3 months at first visit were assessed after disease age of at least 6 months. Patients with unclassified arthritis (UA) and classified as RA were included. Patients using drugs other than non-steroidal anti-inflammatory drugs (NSAID) at first visit were excluded. Glucocorticoids were given if NSAIDs failed to induce remission. Patients were interviewed with telephone and those accepted were admitted to the outpatient clinic. Patients were telephoned for 3 times if first 2 call were missed. There were 135 patients. Among 92 patients interviewed only one refused to participate. 37 (27%) were admitted to outpatient clinics, 54 (40%) were interviewed with telephone. Patients were classified as RA according to either 1987 ACR or 2010 ACR/EULAR criteria.
Results Demographic features were as follows: 66 (73%) were woman, mean age was 50 (19–85) (first admission). Mean swollen and tender joint count was 5 (1–22) and 8 (1–36) respectively. Most frequently affected joints were MCP (50%), wrist (48%), and PIP (32%). Morning stiffness was longer than 30 minutes in 67%. RF and anti-CCP were positive 20%, 17%, respectively. Mean age of disease at the last assessment was 4 years (6 months- 8 years). Patients were classified as RA according to 1987 ACR (8%) and 2010 ACR/EULAR (20%) criteria. Glucocorticoids were given 75%. Mean glucocorticoid dosage was 10 mg (5–50) and 8% patients were given 50 mg equivalent of prednisolon for 3 days in order to induce remission. Drug free remission was induced with NSAIDs and glucocorticoids in 18% and 20% patients respectively. DMARDS were given in 44 (48%) patients (HQ, 45%; MTX, 44%; SSZ 17%; LEF 11%; only 1 patient TNF inhibitors). 13 patients (14%) voiced that although they were given DMARD, they stopped to take DMARDs and they were symptom free for approximately 3 years.
Conclusions Early arthritis patients with the diagnosis of unclassified arthritis or RA were assessed. Drug free remission was achieved in approximately 40% of the patients. These patients were still symptom free after about four years. Nearly half of the patients were given DMARD although only 20% of the patients fulfilled either 1987 or 2010 criteria. About 10% of the patients stopped taking DMARDs although given and they were symptom free. There are contradictory results about efficacy of MTX in probable RA and UA in disease progression. Along with these results, we are still in the need of criteria that would indicate the early arthritis patients to start with DMARDs so that we would neither be late nor avoid any unnecessary prescription.
Arnet FC, Edworhy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31:315–24.
Aletaha D. Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: An American College of Rheumatology European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2010:69;1580–8
Disclosure of Interest None declared