Background Early arthritis (EA) is one of the difficult patient groups with the right timing of disease modifying anti-rheumatismal drugs (DMARDs).
Objectives To assess long term outcome, drug free remission rates of patients with EA and classification based on 1987 ACR (1) or 2010 ACR/EULAR (2) rheumatoid arthritis (RA) criteria.
Methods Patients with arthritis with symptom duration of at least 3 months were assessed. Unclassified arthritis (UA) or patients classified as RA were included. Steroids were given if NSAİDs 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 was missed. Among 135 EA patients, 82 were interviewed; only one did not want to participate. 36 (27%) were admitted to outpatient clinic.
Results Demographic features were as follows: 57 (71%) were woman, mean age was 50 (19-82) (baseline). Mean swollen and joint count was 5 (1-22) and 8 (1-36) respectively. Most frequently affected joints were MCP (54%), wrist (48%), and PIP (31%). Laboratory findings were as follows: RF positivity 22%, anti-CCP 25%. Mean age of disease at the last assessment was 4 years (6 months- 8 years). Patients were classified as RA according to 1987 ACR (6,7%) and 2010 ACR/EULAR (18, 22%) criteria. Steroids were given 75%. Mean steroid dosage was 10 mg (5-40) to induce remission. Drug free remission was induced with NSAIDs and steroids in 14 (17%) and 16 (20%) patients respectively. DMARDS were given in 51 (62%) patient (39 (48%) hdroxycloroquine, 37 (45%) methotrexate, 14 (17)% sulfasalazine, 10 (12) leflunomide). Twelve of the patients voiced that although they were given DMARD, they stopped to take DMARDs and they were symptom free for approximately 3 years.
Conclusions Patients with the diagnosis of unclassified arthritis and RA were assessed. Drug free remission was achieved in approximately 40% of the patients. These patients were still symptom free after about three years. More than half of the patients were given DMARD although only 20% of the patients fulfilled either 1987 or 2010 criteria. There are contradictory results about the benefit of MTX in probable RA in disease progression (3, 4). Along with these results, we are still in the need of criteria that would indicate the early arthritis patients to start with DMARDs.
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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.
van Akemans L, Gillet-van Dongen H, et al. Five-year outcomes of probable rheumatoid arthritis treated with methotrexate or placebo during the first year (PROMPT study). Ann Rheum Dis 2014:73:396-400.
van Dongen H, van Aken j, Lard LR, et al. Efficacy of methotrexate treatment in patients with probable rheumatoid arthritis: a double-blind, randomized, placebo-controlled trial. Arthritis Rheum 2007: 56:1424-32
Disclosure of Interest None declared
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